EOB
Denial Reason
Job Aid
Process
Payor Portal
100
Where do you find the EOB's for your denials?
What is Epic Liability Bucket?
What is Payor Portals for BCBS and SWHP?
What OnBase Combined Query?
100
Denial reason when you see this remark or adjustment reason codes:
What is Medical Records?
100
Aeos worklist, pending days and Midas appeal status
What is Aeos and Midas Workflow Process located in Appeal Writer's Sharepoint under Important Files and Links?
100
Midas Log In
What is BSWConnect - Midas Event?
100
Payor portals used to follow up on appeal's decision.
What is SHWP/Firstcare/Rightcare, UHC, Cigna, BCBS.
Hint: Availity for BCBS follow up on accounts medical records upload to Availity by RN.
200
Denied procedure and denial reason on this EOB:
What is No authorization denial for HCPC Q9967 and CPT 71260?
200
Pre-certification/authorization exceeded denial
What is identifying what is authorized?
200
Patient Consent Documents Location
What is the Collector ->Job Aides->Patient Consent Documents
200
The process for Procedure or diagnosis inconsistent with modified/required modifier missing. HIM reviewed case before sending to DRC.
What is sending an email to HIM for secondary review?
200
Decision letters are mostly statements
What is the UHC portal?
300
Incompatible revenue codes approved versus billed
(EOB inpatient denial for billed revenue code different from approved revenue code)
What is level of care denial?
300
Claim denied because previous stay was within 30 days of admission
What is re-admission?
300
Location of system links, Job Aides and dept. meeting notes
What is Collectors' Sharepoint
300
BCBS Out of State Plan Process
What is ask BCBS TX rep to connect the call to home plan rep?
Hint: Always get decision from home plan and not BCBS TX plan.
300
New claim number is given every upload or appeal status
What is Superior Portal?
400
Denial type and code denied for this EOB:
What is MUE denial for CPT 15275
151 - Payment adjusted because the payer deems the information submitted does not support this many/frequency of services
400
Approved NPI is different from billed NPI
What is calling payor to update NPI on authorization and request for re-process?
400
Update yourself weekly location
What is Collectors' SharePoint --> Weekly Bulletin
400
Productivity total reported incorrectly on one of my work day.
What is contact Tashauna to check report uploaded?
400
Scott & White Payor with all number claim numbers
What is RightCare and FirstCare?
500
UB and EOB does not match total bill
What is missing EOB?
What is a split claim?
500
Denial is confusing or unclear
What is calling the payor for clarification?
500
Template for Follow Up Situational Workflow
What is the DRC Follow Up Collector Policy?
500
EPIC Expected Reimbursement
What is the contractual expected payment?
includes line item charges, DRG, and Stop Loss
500
Payor states appeal not received when appeal was uploaded in portal
What is check the payor portal on status of initial submission?