If a claim denies as a duplicate is it member or provider liability?
It is the provider liability.
100
Institutional claim 142304075000 for Curt Jacobsen, YEM807834327. What was the original denial for this claim?
What is COB - Coordination of benefits questionnaire has not been returned.
100
How can I tell the difference between a paper claim and an electronic claim?
Paper claim does not have an EC at the end of the description.
100
What is the report that I would use to locate a professional claim?
What is 837P
100
When using EAGLE what must all Users be signed into?
NOLTS
200
Jason Strohbehn is calling about DOS 10/22/14 he states his office visit was denied as a duplicate. What is the original claim that processed and what is the duplicate claim numbers?
original 143024530800 duplicate 143096410400
200
Claim 150076090300 for Sherry Purvis; EHN857731017. What is the original denial for this claim? Have we received a new or corrected claim?
Claim 15076090300 denied did not meet diabetic education criteria. New/corrected claim 150076090302 was received and reprocessed on 4/21/15.
200
What is the document type I would use to find a Returned claim?
Letter - Return Unit
200
How would I search for a Medicare Crossover claim?
Use 00 rather than the Prefix.
200
Where can I find the Optional Accums number?
Coverage Inquiry under the Accums tab
300
Sharyn Neben; YED827334243 calling about DOS 4/23/14 claim is for $89.00. Member states we did not pay anything on this claim, WHY?
What is claim - 141191459701 denied as a duplicate to 141417728900 which denied inclusive to another service/procedure. This is not the member's liability and the provider should not bill her for this.
300
Claim 142907564900 for Lando Rejda; UNE887872150 - why did this claim deny?
What is no coverage for Routine eye exam.
300
Can I see appeal/reconsideration notes in Document Search?
No I would need to use Macess to see them.
300
How long after it has been submitted can a claim be pulled from Foresight?
90 days
300
When viewing the accums report in Eagle, how would I know if it is an Institutional claim or a Professional claim?
The 4th column would have 1 - Institutional or 2 - Professional.
400
This is a FREE SPACE
FREE Space
400
Why was professional claim 150158659400 denied?
What are expenses incurred prior to coverage effective date.
400
Using Document search why was claim 150695926600 for Anthony Ivaskevicius; ODD817913623 returned?
The diagnosis code(s) are missing, not legible or are invalid. Please verify the place of service. The procedure code(s) are missing, not legible or are invalid. The name and credentials of the provider, Federal Tax Identification
number or NPI are missing.
400
What does the Error 32523 stand for and can CSC handle it?
BCBSNE Rule: 837P - HME procedure requires 'RR' or 'NU' modifier. Yes we would advise the provider which line requires an RR or NU modifier, claim must be corrected and resubmitted.
400
How many Outpatient Therapy sessions did Jason Strohbehn, UNE857453038 use in 2014? What are the dates?
8 sessions used dates are March 18, 21, 25, 27, April 1, 3, 11, 15
500
Adicen Jones NPD837587742 would like to know how many claims have been denied as treatment of infertility in 2015.
What is 5 they are claims:1508211177 1508211368 1505611026 1505011079 1502314740
500
What is acceptable proof of timely filing for providers?
What is The only proof we will accept is a copy of the Claims Confirmation Report issued by BCBSNE to indicate the claim was filed within timely filing limits and was successfully transmitted; and the claim does not appear on the BCBSNE NPI Edit Report and/or the BCBSNE Quality Edit Reject Report. We do not accept copies of the provider’s ‘screen shots of their system showing a date they filed BCBSNE’.
500
Can I view electronic claims in Document Search?
No I would need to use Foresight to do that.
500
To find the UBOK # where would I look in the raw data?
Ref* D9*
500
When did Bradley Hans, YED847393539 meet his family deductible? What is the claim number and who was it for?