It's a Numbers Game
This is the code you use do deny 0001A if your medical plan is Dual
what is COVID01
this is the tab where you get the duplicate claim to compare to yours
what is the Edit tab
Contract: 60.20
Allowed: 89.21
Provider Paid: 22.00
Deductible. 60.20
Co-insurance: 5.01
POS: 13
What is PAY
95861 mod 26
2 units
What is 151.97
This is the rule for Edit 532
What is : check for corrected; if so; P29 check claim against original claim, let deny if duplicate. deny additional lines as needed. Unless B code, then ok select if overlapping dates
These Numbers, after the letters PR, tell you if money should be allocated as Deductible, Co-ins., or Co-pay
what is PR-1, PR-2. and PR-3
This TAB is where you can "start your claim over"
What is Edit
Contract amount: 25.36
Allowed: 51.02
Paid amount: 25.36
Deductible amount: 23.00
Co. insurance: 0.00
POS: 02
What is DENY
95966 mod Q6 2 units
what is
If this is for a secondary claim Edit 225 or 293, pay the full PR
This is the rule for Edit 151 "Modifier Required"
Okay to Select if it is “Modifier required”
This is the phone number for the Help Desk?
What is 213-694-1250 x4444 opt 1
This tab lets you remove a denial entered by mistake
what is the EDITS tab
Contract: 56.25
Allowed: 95.00
Paid: 0.00
Deductible: 77.00
Co.ins: 1.27
POS: 30
What is PAY!
Pay or deny: 95872 mod 51
Paid: 73.45
Ded: 0.00
Co-ins: 1.21
what is 72.52
This is the rule for CO-49
49 - This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Solution: We become primary, check for an authorization. If an authorization is present, pay as primary. If no authorization, deny for no auth. Unless: Check UM DTP, some services does not require auth such as LABS Services.
These numbers follow the letter D when a line/claim is denied for Incorrect Billing
what is 110
This tab shows you type of MCLA plan
What is CLAIM
Contract: 85.25
Allowed: 85.25
Paid: 0.00
Deductible: 0.00
Coins: 0.00
POS: 33
What is DENY
Pay or Deny: Edit 293 E0198 2 units mod RR
Paid: 32.35
DED: 0.58
Co-ins: .36
what is contract 36.85; >pay 32.35
difference =4.5> PR 0.94
pay .94
This is the rule for 1149
let deny if you can validate on the claim image the upn number is missing or invalid
This is the code we pay as secondary at 0.00 without an EOB
What is G9008
this tab is where you select "claim" or "claim lines"
what is the COB tab
Contract 45.00
Allowed: 71.11
Paid 52.00
Deductible 5.00
Co. Ins 6.50
POS: 31
What is PAY
PAY or Deny:
Edit 225: E0140
EOB: Paid amount $211.57 Ded: 0; Co.ins:: 5.52
E0140 Contract = 210.56*.99=208.45
Contract 208.45 is LESS than paid 211.57
Line denied D100
This is the rule for the $ amount allowed for code G9008
What is zero