Insurance & Claims Processing
This document confirms how much the insurance paid, denied, or adjusted
what is EOB?
Carc code-18
What is duplicate?
Commonly used modifier for a BCBA
what is HO?
The crosswalk for 97153
What is Code H2019?
This is the amount a patient must pay for health services before their insurance begins to pay.
What is a deductible?
a process where the insurance company must approve a treatment plan before services can be provided.
what is Authorization?
BCBS FEP does not take this loaction
What is POS 03?
The cross walk for H0031?
what is 97151?
True or False: You should wait to receive the EOB from the primary payer before submitting to the secondary.
What is TRUE?
Carc code/adjustment code- 3
What is PR: Co-payment Amount ?
This term refers to the amount a provider agrees to write off due to a payer’s contracted rate.
what is contractual adjustment?
This is the TF for UMR
what is 180 DAYS?
The code for "Family adaptive behavior treatment guidance"
What is 97156/S5111?
This document is typically required before billing a secondary insurance?
What is the Primary EOB (Explanation of Benefits)?
This is the portion of the medical bill that the patient must pay out-of-pocket, often due at the time of service.
What is a copay?
When billing ABA services, this unique number identifies the provider to the insurance company.
What is a National Provider Identifier (NPI)?
Tri-west must have this on the claim
what is the time?
This modifier might be required when billing 97156 in some states or plans?
What is Modifier HO?
Modifier Used for Telehealth
what is 95/GT?
a service that is included under a persons insurance plan.
what is a covered benefit?
The same service billed more than once for the same date or session
what is a duplicate claim?
Cigna 97151 only accept this much units
what is 8units?
We now have to get auth for this Location for MBHP
what is pos 99:other?
for Cencal as a QAS provider this modifier is used
what is No Modifer?
needs to determine which payer is primary or secondary
What is Coordination of Benefits