Claims
This is another name for a UB04.
What is "CMS-1450"?
This reimbursement rate is a fixed amount for each day the patient is in-house.
What is "Per diem"?
What is "Sequestration"?
What is "FollowUp"?
Use this level 3 UFC code when follow up from the facility is needed...
What is "FUND"?
When requesting a rebill, this needs to be selected to ensure the claim generates.
What is "Create Claim"?
This determines the patients level of care.
What is the "Accommodation Code"?
This tool is used to view the current contracted rate for all contracted insurances...
What is the "Contract Grid Tool"?
To pull/view a UB04, go here in OHPAC...
What is the "DM View" link?
What is "Level 2 - COBI; Level 3 - LTPT"?
Black and White copy of the UB04 is commonly used for these higher payment disputes.
What is an "Appeal"?
What is the "Insurance Plan Code"?
Authorization for services were not obtained, this action is needed to reconcile the account for a loss in revenue.
What is "Request a Write Off"?
Use this Category and Comment Code when placing a claim on "pause" to be reviewed by the billers.
What is "FollowUP and Rebill Request"?
This code is placed on an account for reasons like, identifying accounts with payer issues, tracking trends and escalations...
What is a "UFC code"?
What is "RH (Relay Hold)"?
This reimbursement rate is based on a fixed amount based on the HIPPS pricer.
What is "CMG rate"?
You will use this category and comment code to request an adjustment.
What is "Category: Request & Comment Code: ADJ Request"?
UFC's can be added removed or edited from here in OHPAC...
What is the "RG Actions button"?
This Level 5 UFC is used to track confirmation from the Facility to determine if the admission is workers comp or auto related.
What is "AILA"?
This is the action you will select to request a rebill.
What is "Determine Insurance Receivable Billing Status"?
Estimated Reimbursement depends on of the billed charges are more or less than our contracted rate due to this.
What is the "Less of Clause"?
This state program assists low-income Medicare Beneficiaries with Medicare Part A and Part B premiums and cost-sharing, therefore these individuals cannot elect to pay any patient responsibility applied by Medicare.
What is "QMB"?
This Category and Comment code is used when appealing denial for Timely Filing.
What is "Appeal & Appeal Needed"?
This is the denial reason when the insurance denies the claim stating patient no longer has benefits because they have used them all.
What is "Benefits Maxed"?