Documentation
Coding
Claim types
Where do i find it?
Denials
100

If a provider calls in on claims status what is your subject and category? 


Claims Status


100

This type of code has two digits and is only found on professional claims. What is it ?

Place of service codes


100
This type of claim must be received within 180 days from the date of service what is it? 

Original claim

100
where can i find a claim denial?
Line item details, Line item pricing, Disallow amounts, Claim information, Notes
100

Z55 

Provider not eligible by contract for payment


200

If a provider is calling on Eligibility Status what is your subject in category?

Eligibility /Verification 

200
This type of code is found on hospital claims what is it ? 

Rev Codes


200

This type of claim is indicated with a number 7 in box 22 or the 3rd digit of the bill type, what is it ? 

Corrected claim. 

200

Where can i find a provider Agreement ID ? 

Line item pricing or Member provider tab

200

R47 

Payment reflects COB

300

If a provider is calling in to see if a code requires Authorization Status what is your subject and category ?

Authorization / Authorization Inquiry
300

This type of code is billed by ancillary providers, what is it ? 

HCPCS

300

This claim must have attachments in order to be processed what is it ? 

EOB claims ( Secondary) 
300

This tab is your best friend what is it ?

Notes Tab

300

ZDL

Benefit Not Covered
400

If a provider calls in on claim appeal status what is your subject and category? 

Claim / Claim Appeal

400

This type of code tells us what is wrong with the member or patient, what is it? 

Diagnosis codes
400

This is received within 90 days from the claim denial date, what is it ? 

Claim Appeal
400

This tab will only be used if the claim was processed as secondary, what is it?

COB tab

400
This denial is seen when a provider does not receive the proper approval, WHAT IS IT 
No authorization / no referral
500
What is all of the required information we must have in our notes for claim status ? 

Claim # , Dos, Tc, Why they called, what we told them, ref # 

500

What are the different versions of Diagnosis Codes

ICD- 9 and ICD-10 

500

If claims are not received in time they will deny for this, what is it? 

Timely Filing

500

Under this i can find if a specific date of service was denied under an authorization, what is it? 

LOS Summary

500

What are the two denials will be seen if a provider does not bill an original claim number?

Invalid PCCN or A16 missing original claim number 

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