Codes
The code used to identify a claim was Adjusted and Paid
15
The date a member was seen
Date Of Service
Letter that member gets notifying member of a service payment being rejected
Denial Of Payment (DTR)
The place you call regarding chiropractic claims
Fulcrum
The turn around time you quote a member when sending a task to FulfillmentWB
10 business days, plus mail time
The code used to identify a services is not covered
77
The amount we are contracted to pay provider’s
Allowed amount
Data on claim is complete and accurate enough to pay the claim.
Finalized Claim
The place you warm transfer dental claims to
Delta Dental
The address the providers can submit medical claims to
Attn: UCare Claims
PO Box 70
Minneapolis MN 55440-0070
The code to identify other insurance primary, submit their EOP with UCare claim #
60
Amount the plan has paid plus the member
Paid amount
Insurance company with first responsibility for the payment
Primary insurance company
The task used in fuse to look up claims
Medical Claim Inquiry
The turn around time for replacement claims
30-60 days
The code used to identify a covered benefit
09
The section in FUSE that indicates if t's the member or providers responsibility on a claim
EX/HR code
Is a two-digit numeric, alpha-numeric or alpha code that is used to indicate that the service or procedure.
Modifiers
What are the five ways a member can appeal a decision
Portal, In Writing, Phone, Email to A&G, Form
Name the plans that are not eligible for reimbursement
(PMAP, MnCare, Connect, Connect + Medicare, MSC+, and MSHO)
The code used to identify a duplicate claim
72
This indicates the number of days treated, the number of items a member received, or the number of treatments done
Units billed
A resubmission of an incorrectly paid claim due to a billing error or a third-party payment.
Replacement Claim
What we tell the callers when discussing Claims, Bills and Denials without placing blame in the providers
Say that we have notified their provider we need more information from them. Confirm that this is not a bill, and that their provider will not bill them for these charges.
The place you need to send a claim to when action needs to be taken or you have questions about a claim
ResearchWB