Billing Indicators
This billing indicator must be applied to all account being routed to the Denials Team
1005
AR-Revenue Recovery
This account activity must be applied to every account you work summarizing the actions you have taken on the account--It is how you get credit for productivity!
248
Add Account Note
For account balances $25K and greater, we are to follow-up after this many days
Every 7 days
This many days is allowed for a payer to process or claim, requested documentation prior to routing to PSO for a payer delay
60 days
If a claim is denied for COB issue for total charges less than $10K, AR will route the account to this department for further review after we have exhausted our work efforts per the COB job aid
Claims Services-COB review needed
This Billing Indicator must be applied to remove the account from WQ 14489-Eligibility
2120
Eligibility Issue Review Completed
This account activity is used to manually add an account to a WQ
302
Add to WQ/Select the WQ
For non-contracted payers, AR will route these admission types to the NSA team for review
Emergent/Urgent
In order for an account to qualify for Transplant inventory, this must be verified as "active" in patient station for the DOS billed
Episode/Status
If Claim Services returns an account for COB issue as they are unable to resolve, AR will take this next stop to resolve the account.
Move total charges to self-pay and apply a self-pay discount @ 65% with adjustment code 173
This Billing Indicator is used to route to cash team to research a missing insurance payment that is $25K or greater
MHD
Missing Insurance Payment $25K or greater
This account activity is used when two or more items are needed for upload or mail out. (I/S, MR, and Reconsideration form)
749
Packet needed
Medical record requests for account balances with this dollar amount require to have Support attach an itemized statement as well
$50K
We allow this many days for a non-contracted payer to process our claim prior to billing the patient if no payment/correspondence has been received
90 days
This account activity must be added if the patient has been unresponsive to letters/phone calls to resolve COB issues
406-COB Issue Patient Unresponsive
This Billing Indicator is used in WQ 11406-Dual Buckets when no action can be taken to resolve the dual buckets
1051
Dual Liability Bucket No Action can be Taken
This account activity is used for missing/Incorrect Charges, Rev Code Discrepancy, CCI Edits, Medically Unlikely Edits (MUE), Charge Discriptions, DOS, CPT/HCPC or Modifiers (any CPT/HCPC NOT listed under "Procedures" in the Coding tab
621
Charge Capture PFS Request
For plans that apply a level of care reduction to ER services, we will only send to denials to appeal for these CPT codes
99284 and 99285
If plan denies or recoups payment on a claim for coverage termed and total charges are $10K or greater, we must add this BI and route the account to this WQ if EES has not already reviewed for financial aid/other coverage.
BI 1059-EES Post Disch Review Needed
WQ 17258-HB EES Post Disch Review Needed
If total charges are $10K or greater and denied for COB issue, AR team will take this action if work efforts have been exhausted per COB job aid
Manually add account to WQ 10937-Management Escalation WQ requesting Analytic Team review with detailed explanation of what actions have been taken on the account
When working the Eligibility WQ, these 3 Billing Indicators must be applied if the account was registered under the incorrect plan code
975-Plan Code Error
2107-Coverage Update Needed
2120-Eligibility Issue Review Completed
This account activity is used for DX, DRG, DX Related to Hospice Review, Discharge Status, Admission Source Type, IP accounts that need combined per Nurse Audit, any CPT/HCPC listed under "Procedures" in the Coding Tab
1223
Coding Review Needed from PFS
When UHC applies PR96 for private room and board, this action is to be taken on the account.
Adjust the PR96 amount to contractual
When MR is submitted to the payer and the payer states the MR was not received, this information must be obtained from the call.
-verify documentation was submitted to the correct address
-Escalate account if documentation submitted certified and delivered to the correct address per USPS
-If not submitted to the correct address, obtain the correct information of where to submit the documentation
This document is used to help overturn a COB denial if the patient has one signed on file
Signed COB letter