Name That Code!
This code would indicate that a determination was not made in the time frame allowed for a decision.
What is Y7?
Under this tab, you would find a summary of benefits & coverage categories.
What is the benefits tab?
What it timely filing?
This is the TAT (turn-around-time) for a pre-d to process.
What is 3 business days?
Hovering over this little blue thing offers additional claim details, including whether or not the provider was INN/OON, and if there are OON benefits available
What is the blue info circle (variations in answers should be considered lol) ?
A particular duplicate submission code; decision has been applied to this request
What is N3?
Under this tab, you can explore whether or not benefits are covered under a mbr's plan. *This is used for inquiry purposes only
What is the Estimate Procedure tab?
Medicaid rules state that a claim must be received within this specified time frame for consideration/processing.
What is 90 days from the date of service?
Typical TAT (turn-around-time) for an electronically submitted claim?
What is 30 business days?
In the claims view, this date is also known as the "date of service".
What is the treatment date?
A tracking code that indicates a provider's W-9 is needed to complete processing of a claim.
What is T5?
Charlie is not happy with his current PCD and is exploring other options. You can use this to assist Charlie with options in his area.
What is the change/search provider tab?
All Medicaid claims, even with a valid delay reason, are required to be submitted within this specified time frame.
What is within 2 years from the date of service?
This is the TAT (turn-around-time) for an adjustment to process, once it has been placed and tracked in CSapp.
What is 14 days?
This column in a claim, is what we all like to see with zeros; especially the "patient".
What is patient responsibility?
Tracking code used to place an adjustment for a claim that has been processed with only a Y7 exp code. This type of adjustment is placed in the messages and tracked differently than those placed under the "place adjustmen"t link found in the claim view.
What is C16?
Chaniece is calling re: wanting to know the status of her pre-d. Click on this green tab to locate it.
What is the claims/estimate a procedure tab?
If provider has proof that claim was submitted within timely filing, (such as a screenshot showing submitted to clearinghouse), they can submit it along with this.
What is a provider appeal?
This is the typical TAT (turn-around-time) for specialty referrals to process, once received.
What is 3 business days?
What is exp code 99?
This denial code pertains to when a provider that submits a claim, was excluded (opted out) under federally funded plans, and submitted a claim for a federally funded plan (Medicaid or Medicare).
What is Y6?
This blue tab is a helpful way to find out the date that a service was last rendered. You can also quickly find services rendered on a specific tooth #, quadrant, or area.
What is the service level view tab?
The denial code indicates that a Medicaid claim was not received within the specified time frame. Providers can not charge a mbr for denied services under Medicaid Guidelines.
What is C6?
Typical TAT (turn-around-time) for dated paper claims submitted via US Mail.
What is 45 days?
Show me the $$$! This feature includes print date, mail date, clear date, (if applicable) and is found in the claim view.
What is check information?