Insurance & Claims Processing
This is the maximum number of days after the date of service that a claim must be submitted to the insurance company to be eligible for reimbursement
What is the timely filing limit?
Carc code-18
What is duplicate?
This code is used for treatment planning
what is 97151?
The crosswalk for 97153
What is Code H2019?
Carc code/adjustment code- 3
What is PR: Co-payment Amount ?
This document confirms how much the insurance paid, denied, or adjusted
what is EOB?
BCBS FEP does not take this loaction
What is POS 03?
This is the modifier for LA CARE H0031 (BCBA)
what is HP?
True or False: You should wait to receive the EOB from the primary payer before submitting to the secondary.
What is TRUE?
a service that is included under a persons insurance plan.
what is a covered benefit?
a process where the insurance company must approve a treatment plan before services can be provided.
what is Authorization?
Max Units we are able to bill for 97151, if there is an overage what do you do?
What is 8 units, NBS the remaining.
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)?
needs to determine which payer is primary or secondary
What is Coordination of Benefits
The same service billed more than once for the same date or session
what is a duplicate claim?
when we see "TEMP AUTH" on a timesheet we...
what ADD LABEL/ HOLD claims?
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?
This is the amount a patient must pay for health services before their insurance begins to pay.
What is a deductible?
This term refers to the amount a provider agrees to write off due to a payer’s contracted rate.
what is contractual adjustment?
When billing BS promise we bill under this entity, and we do what with box 32?
what is STAR of CA, we removed facility from box 32
UBH Modifier for 97155 (BCaBA) Telehealth
what is HN, 95?
for Cencal as a QAS provider this modifier is used
what is No Modifer?
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?