Abbreviations
SNF
Skilled Nursing Facility
--differs from Home Health and Hospice
Denial code 119 indicates the patient has reached the ________.
Maximum Benefit Reached
When Ohio Medicaid eligibility is inactive/termed, the balance should be transferred to ________.
patient
UPN
Universal Product Number
-Depending on the insurance, UPN goes in BT item page, box 19, or sales order
Denial code 22 indicates the service may be payable by ________.
another payer
The Homelink claim required the ________ modifier because the correct insurance was linked to the Medicare Region C price table.
KXx
QMB
Qualified Medicare Beneficiary
-ONLY pays for deductible and coinsurance/copay
Before resubmitting a Health Net claim denied for a missing UPN, the UPN should first be verified in ________.
BT and UPN spreadsheet
When reviewing an authorization, the approved codes, units, effective dates and ________ details must all be validated.
quantity
EOB
RA
Explanation of benefits
Remittance Advice
For Aetna, an account exceeded the allowed ______ units within 90 days.
600
When primary Medicare pays more than the secondary Medicaid allowed amount, the appropriate resolution is a ________.
Credit Adjustment
CAP/MCO
CO-24 Denial
Capitation Managed Care Organization
Denial code 197 indicates that required ________ was absent.
Prior Auth
--this could be branch or insurance not always the PA
Michigan Medicaid claims for urology items were adjusted as “secondary ________ with branch.”
Not Contracted