Insurance & Claims Processing
What we call government insurance in California
What is Medi-Cal
also referred to as Remittance Advice (RA)
What is an EOB (Explanation of Benefits)
15-minute unit face-to-face adaptive behavior treatment sessions delivered by a technician under the supervision of a qualified healthcare professional (QHP)
What is 97153 or H2019
claims are reviewed and payments decisions are made by payer
What is Aducation?
a business entity that consolidates claims and transmits to the 3rd party payer
What is a clearing house or What is Waystar
Rendering provider for this modifier is a mater’s level clinician
What is BCBA (HO)?
CMS 1500 form filled out without mistakes
What is a clean claim?
When the original reference number or claim number required
What is Frequency code 7 (Replacement) or 8 (VOID)
QAS paraprofessional without a certificate or license and has a high school diploma
What is HM modifier?
The percentage owed by the policy holder
What is Coinsurance
needs to determine which payer is primary or secondary
What is Coordination of Benefits
POS 2 AND 10
What is 95 or GT modifier?
can be filled if heath care professional or patient feels claim is wrongfully denied
What is an appeal?
Claim that is held in a pended state because of an error or need for more information
What is a suspended claim
This code covers the time spent educating parents or caregivers on strategies to support the patient’s treatment plan outside of therapy sessions.
What is 97156?