Facility Information
The number of active locations we bill for (not Entities, just the locations).
What is Four?
The type of form the Physician claims are billed on.
What is a 1500 form?
The type of form Facility Claims are billed on.
What is a UB04?
The payer we do not submit any low reimbursement appeals to.
Who is BCBS?
This reason code indicates patient responsibility applied to copay.
What is PR3?
Our biggest commercial payer.
Who is BCBS of TX?
The unique identifier for healthcare providers, typically found in box 32A or 33A for physician claims.
What is the National Provider Identifier or NPI?
The three types of plans our facilities do not accept.
What is Medicare, Medicaid, and Tricare?
The term used to indicate a payer paid our claim at a lower evaluation and management fee than what we billed to them.
What is Downcoded?
The 4 pieces of information needed to submit a Workers Compensation Reconsideration.
What is the claim form, the medical records, the Itemized Statement, and the Reconsideration letter?
The title of our contact at each location for Front Desk issues.
What is the FA or the Front Desk Lead?
The box number you would add the frequency code and claim number.
What is box 22A & 22B
How many units are billed on an evaluation and management charge.
What is 1?
The allotted time frame we have to submit TDI Open Negotiations for Physician claims, from the EOB paid date.
What is 90 days?
The 10 digit number assigned to differentiate drug type and manufacture.
What is the NDC Code?
One of the facility locations sold in 2020.
What is San Antonio or Austin?
The subscriber code for a subscribers' Child.
What is 03?
Our admit type code indicating Emergency, typically found in box 14.
What is 1?
What is Services Not Documented or CO150?
A letter the insurance sometimes sends to the patient requesting additional information if they think there may be another payer responsible for the billed claim.
What is a COB (coordination of benefits) or Accident Questionnaire?
What is 2016?
A unique 10-character code that designates a providers specialization.
What is a Taxonomy Code?
The the diagnosis code that indicates the reason the patient came in to be seen, which is separately indicated on the Facility claim forms.
What is the Reason For Visit DX Code?
This type of plan allows for a maximum number for ER visits in a benefit year. You can bill the patient if they have already reached their assigned number of visits for the year.
What is a Limited Benefit Plan?