HOLD the Ketchup
SCREEN 3
ACTION!
Send a LETTER
ENTER here
100
Holds a claim to check for other insurance
What is OF
100
You can find a history of claims on this screen
What is CL1081?
100
Action code to add a new claim
What is A
100
The provider received this letter to notify him why the claim was not processed yet.
What is DLY?
100
The indicator that a claim is processed as in network.
What is capacity code?
200
Informs the user that the services may be pre-existing
What is 31
200
COB details on a HCFA are entered here.
What is F14 COB pop up window?
200
The user must use this action to review the next service line
What is NS
200
The hospital received this letter asking them for admission and discharge records for a specified date.
What is IFP?
200
The details of the primary carrier are saved here.
What is ME1013?
300
This hold code denies the service as an excluded item
What is BE
300
All claims are adjudicated and completed on this screen.
What is CL1034?
300
This action reopens a claim from 'A' status to allow the user to make changes.
What is RO
300
The member received a letter requesting accident details.
What is ACI?
300
Product type that indicates a claim is processed as a dental benefit.
What is D?
400
This hold code is tied to a procedure code that requires review of medical necessity.
What is RD
400
You can add a customized statement on this screen to enter into a fill-in letter.
What is CO1051?
400
When a response is received to a request letter, this action is used to reopen the posted claim.
What is ROP?
400
The member received a letter inquiring whether subrogation applies to the billed services.
What is SUB?
400
The party that billed the claim and will receive the payment.
What is a vendor?
500
The hold code that asks you to verify private room necessity.
What is PR?
500
Precertifications and other authorizations are found here
What is CL1011?
500
If this code isn't entered on the CL1033, the COB is not applied and prorated across the service lines.
What is AC?
500
You use this letter to deny a service that has been found to be for a pre-existing condition.
What is PED?
500
Without this code on the claim, you could not determine which network provided the repricing.
What is Mkt Fee (market fee)?
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