Timely Filing
Providers have these many days to submit a corrected claim.
What is 120 days?
The description of the initials EOP.
What is Explanation of Payment?
In reference to a medical claim, this information obtained by a provider is not a guarantee of payment.
What is an authorization?
This place of service indicates that a patient was seen at a hospital as an outpatient for services other than surgery or emergency.
What is 22?
The date by which timely filing is calculated on a HCFA 1500 claim with a service line that has a date span.
What is the From date?
This insurance payment/benefit information goes to the insurance member.
What is the EOB?
Besides Approved, this is the only other status an authorization can be in when a claim can be paid.
What is In Process?
This bill type on a UB claim indicates the member was at a facility as an inpatient from admit to discharge.
What is 111?
The date by which timely filing deadline is calculated on an inpatient facility claim.
What is the discharge date?
The type of services, other than vaccines, that does not require primary EOB when billed on the same day as a THSteps office vist code.
What are lab services?
This department is in charge or approving or denying authorization and loading them into Vital?
What is Utilization Management?
This bill type indicates that a claim is for the first 15 days of an interim stay of one of our members.
What is 112?
The process by which some claim lines are denied for past timely filing and some claim lines are paid because they were received within the filing deadline.
What is Okay edit 311 and deny the lines on the Service Tab?
Apply the primary payment and check date on the COB tab. Okay the timely filing edit. Pay the claim.
This Senate Bill 58 service code does not require authorization.
What is H2011?
This is the CPT code for dental varnish. It is part of the covered THSteps services.
What is 99429-U5?
The action taken on the latest submission when an original claim is received within 95 days, the first corrected claim is received within 120 days from the original paid date, the second corrected claim is received past 120 days from the first corrected claim's paid date and the latest and third submission is received within 120 days from the second corrected claim's paid date.
What is deny the claim with APP01?
Process the claim with this scenario:
Primary EOB segment on file for Cigna has effective date 04/20/2018 and Term date 05/20/2019 and BCBS segment has effective date 05/21/2019 and Term date 12/31/2019. Claim is received with date of service 10/20/2019 with BCBS EOB with payment. Check date on EOB is 12/15/2019.
What is apply primary payment info from BCBS EOB and process claim to pay?
Process this claim:
A non par PCP bills a claim with service code 99394 and 99214. The service line with service code 99214 is the only one that is requesting authorization. There is no authorization on file for the member.
What is deny service code 99214 for no authorization?
This is what the initials HCPCS stand for.
What is Healthcare Common Procedure Coding System?