Claims
Systems
Misc
Specialty Codes
Remit codes
100
This is what you would look up to see if a member has a precert on file
What is URSHI
100
This is the name of the system you use to price a non par acute care hospital.
What is APC Grouper
100
These procedure codes are 5 digits and begin with a letter.
What are HCPCS codes
100
Hospital
What is IP
100
This is the remit code used when code CR00027 is pulled in APC for par providers
What is DEZ
200
This is the number of days specialists have to submit a claim to Aetna
What is 120 days
200
This system allows you to convert ICD9 procedure codes
What is Service Code Inquiry
200
This would be on a referral and allows a physician to provide additional services without needing a precertification.
What is "consult and treat" or 99499
200
Ambulance
What is AB
200
This remit code is used when Burgess price matches billed amount
What is P26
300
For prime plans, this is the option you would choose in CSMINQ to find the network ID
What is RSHUM
300
EPDB stands for this
What is Enterprise Provider Database
300
This type of provider is associated with MRIs and CT scans
What is a Radiologist
300
Radiology
What is R
300
This remit code is used when a non billable G code is pulled
What is D0H
400
Taxonomy code 261QA1903VX goes with these type of claims.
What are ASC claims
400
Name four of the (6) provider types you can select in Burgess
What are Ambulance, ESRD facility, Ambulatory Surgery, Impatient Pysch, Skilled Nursing or Home Heath
400
This is the letter you put on the detail line to split a line in the processing window
What is letter U
400
WIC
What is Walk In Clinic
400
This remit code occurs when the charge is included in the APC rate.
What is D5A
500
This is the name of the standardized form used by physicians, labs and non-facility providers
What is a CMS-1500 form
500
What option in RUMBA do we use to find provider's FI Rate letter
What is Medicare PRVDR rate inquiry
500
100/050/025 is an example of this
What is a concurrency
500
L
What is Lab Work
500
This remit code is used when paying from FI rate letter
What is PF9
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