Timing is Everything
This is the amount of days we must wait between sending an electronic claim and determining that we should submit a rebill for a no claim on file response.
What is 21 days?
This coded comment category and comment code are used for requesting a Bad Debt Write-Off?
What are Category: Request and Comment Code: BD Request?
This payer must be primary as part of the criteria for including on the bad debt cost report.
What is Medicare?
This denial reason would be grounds for appealing a secondary insurance, as it is typically obtained by the primary payer.
What is authorization?
This is the amount of days we must wait between sending a paper claim and determining that we should submit a rebill for a no claim on file response.
What is 30 days?
This coded comment category and comment code are used for requesting a max allowed write-off?
What are Category: Request and Comment Code: ADJ Request?
This primary payer is also known as Medicare Part C.
What is a Medicare Advantage Plan?
An appeal request must contain this backup regardless of they type of appeal.
What is a cover letter?
This is the maximum amount of time that we allow between receiving promise-to-pay information and contacting the insurance to determine where the funds were sent.
What are 14 days?
This coded comment category and comment code are used for requesting a clean or corrected claim to be sent?
What are Category: FollowUp and Comment Code: Rebill Request?
Crossover data at the top of an ERA can be used to find out where this primary payer has sent their remittance information to a secondary party.
What is Medicare?
This drop-down selection is made in the Appeals portal when backup or attachments are missing from a request.
What is a Additional Information Needed?
How long should it take for an appeal request, adjustment request, or an attorney placement request to be reviewed by leadership.
What is one business day?
This coded comment category and comment code are used for requesting an appeal to be approved for submission to an insurance company.
What are Category: Appeal and Comment Code: APPEAL NEEDED?
This primary payer does not automatically crossover to secondary insurances, and is their EOB is the most common rebill attachment needed.
What is Medicare Advantage?
This appeals status is what we search when we are pulling documents for appeals.
What is Backup Needed?
This is the amount of time we must wait from the Medicare Remittance date before submitting a claim to the secondary payer.
What are 30 calendar days?
This coded comment category and comment code are used for requesting an account to be sent to the outside attorney office?
What are Category: Attorney and Comment Code: ATTY PLACMT NEED?
We would perform this action if Humana Medicare is primary and secondary denies for primary pricing applied.
When do we write-off for max allowed with W779?
We should always provide this document when a plan pays per CMG, or a percentage of CMG.
What is the CMG Pricer?