PRICING
THE UB CLAIM IS BILLED WITH REV CODE ONLY LINES AND THEY ARE NOT PRICING.
WHAT IS DENY 672 FOR PACKAGED SERVICE?
YOU GET AN AUDIT FOR INCORRECT EVENT CODE.
WHAT IS BACKOUT CLAIM AND CORRECT EVENT CODE?
NOTES STATE CONTRACTUAL DENIAL PER EVICORE.
WHAT IS DENY MSI?
YOU HAVE A mEV EDIT AND THE E/M CODE BILLED ON THE HISTORY CLAIM DOES NOT HAVE A 25 MODIFIER WHILE YOUR CLAIM IS BILLED WITH A 25 MODIFIER.
WHAT IS APPLY CES OVERRIDE AND NOTATE CLAIM?
YOU HAVE A 329 CLAIM WITHOUT A 322 CLAIM ON FILE.
WHAT IS DENY 329 WITH RA4?
THE HOSPITAL BILLED FOR 9 DAYS, THE AUTH IS APPROVED FOR 7, THE CLAIM HAS BEEN IN THE SYSTEM FOR 53 DAYS.
WHAT IS SEND FOR PRICING OF APPROVED 7 DAYS?
YOU GET AN AUDIT YOU DONT UNDERSTAND.
WHAT IS SEND QUESTION TO NEW DAY BOX AND CC LEAD AND SUP?
THE CLAIM PROCESSED WITH PR TYPE 3 TO DENY PER UM NOTES BUT YOU DONT REMEMBER SEEING A 319 OR 270 EVENT CODE.
WHAT IS TAKE THE CLAIM TO THE INQUIRY SCREEN, SCROLL DOWN AND SELECT THE HISTORY TAB, THEN SCROLL TO THE FAR RIGHT TO REVIEW THE EVENT CODE LIST.
YOU HAVE A mEV CE EVENT CODE AND THE E/M CODE IS BILLED WITH BOTH A 24 AND 25 MODIFER ON ONE OF THE E/M CODES.
WHAT IS DENY MODIFIED (E/M CODE BILLED WTIH 24 AND 25 MODIFERS) E/M CODE AND ALLOW PAYMENT ON THE OTHER.
THE UB CLAIM DOES NOT HAVE A MEDICARE ID IN THE BOX AND HAS NO PRICING.
WHAT IS RELOAD THE PROVIDER ID?
YOU NEED TO RETRACT THE CORRECTED CLAIMS LETTER SENT IN ERROR.
WHAT IS ADD THE NOTATION NOTRWKUPHDD/MM/YYYY
THE NON PAR PROVIDER CLAIM HAS A 319 PEND AND IS SET TO PAY 78.19.
WHAT IS PROCESS CLAIM WITHOUT ROUTING FOR AUTH REVIEW SINCE THE PROVIDER IS NONPAR AND PAYING LESS THAN 500.00
YOUR E/M CODE WAS BILLED WITH A 24 MODIFER AND DOES NOT HAVE THE SAME DIAGNOSIS CODES AS THE OTHER CLAIM BUT IS STILL HITTING THE mEV EDIT.
APPLY CES OVERRIDE AND NOTATE.
YOUR TOB IS 329 AND THE HISTORY SEARCH SHOWS A 322 ON FILE DENIED WITH RA2. THE 329 IS BILLID WITHOUT A HIPPS CODE.
WHAT IS MARK UNCLEAN AND DENY 622?
HSS AND WEBSTRAT CANNOT PRICE AND THE MEDICARE ID HAS BEEN VERIFIED WITHIN A 30 DAY TIMEFRAME AND DETERMINED MISSING/INVALID/CLOSED.
WHAT IS DENY UBI AND NOTATE?
YOU DID NOT MARK THE CLAIM UNCLEAN AND CLAIM IS ALREADY FINALIZED.
WHAT IS ADD A NOTE THAT THE CLAIM IS UNCLEAN?
THE CANCER CENTER CLAIM HAS LINES PENDING AUTH FOR INJECTIONS AND THE AUTH ON FILE HAS NOTES WITH DOSAGE AND FREQUENCY SPECIFICATIONS.
WHAT IS REVIEW CLAIM IS IN SDR QUEUE AND IF NOT SEND TO HAVE MOVED?
YOU HAVE AN mEV EDIT AND THE PROVIDER SPECIALTIES ARE NOT THE SAME. FOR EXAMPLE ONE IS AN ENDOCRINOLOGIST AND THE OTHER IS A CARDIOLOGIST.
WHAT IS APPLY CE OVERRIDE AND NOTATE. DO NOT CONTINUE WITH THE EVALUATION AND MANAGEMENT SERVICES SOP.
YOUR CLAIM WAS RECIEVED A MONTH BEFORE THE PROCESSED HISTORY CLAIM BUT THEY HAVE DIFFERENCES BETWEEN THE TWO CLAIMS.
WHAT IS DENY THE CLAIM 627.
HSS AND WEBSTRAT CANNOT PRICE AND THE MEDICARE ID HAS NOT BEEN VERIFIED WITHIN A 30 DAY TIMEFRAME?
WHAT IS SEND EMAIL FOR MEDICARE ID VERIFICTION AFTER CHECKING HMEDATA.COM?
THE AUDITORS GAVE YOU DIRECTION AND YOU NEED CLARIFICATION.
WHAT IS DO NOT ASK QUALITY AND SEND QUESTION TO NEW DAY BOX.
THE INPATIENT CLAIM HAS AN AUTH ATTACHED AND IS PRICING.
WHAT IS REVIEW THE AUTH IS FOR INPATIENT AND MATCHES THE BILLING PROVIDER?
YOU HAVE AN mEV EDIT AND BOTH CLAIMS ARE EXACTLY THE SAME.
WHAT IS DENY SECOND SUBMISSION AS DUPLICATE?
A CLAIM IS RECIEVED ON 1/26/2021 FOR A DATE OF SERVICE OF 4/5/2019 AND A HISTORY SEARCH SHOWS THE FIRST CLAIM DENIED LBI ON 6/5/2019. THE PROVIDER IS CONTRACTED WITH UNITED AND NO OTHER CLAIMS ARE ON FILE.
WHAT IS DENY CLAIM DTF?