GSI or RTC
I am in use when correspondence has to be sent to the member or provider.
What is RTC
Provider submitted claim 2 years from DOS
What is Timely Filing Denial Letter
852/870/871
Clinical Edit Denials
NOTE on GSI: Approve 93571-26/52/LM and 93572-26/52/LD. Documentation supports. Please pay 50% of appropriate fee schedule for both line items. S.Vanleer RN 12/4/24
What is Route to Claim Adjustments
Medical records received in Content Manager
What is send to Clinical Review
Use me when a route comes back and states deny a code per Med review
What is create a GSI to send claim to NTT for adjustment
Claim denied for D01- Non-Covered Service
What is a General Denial Letter(No Appeal)
AO5 Denial
What is not Medically Necessary
Additional Information required per RN review is unable to be completed
What is close and send an RFI Letter to provider.
RN states deny code 99214
What is send to NTT