Reason Codes
The split claim Reason Code.
What is 290?
Potassium Citrate with Cranberry
Formulary
The medical code for when PH is claiming Allergies, and Invoice contains Prednisone only.
What is code as Atopy / Allergies?
The correct thing to do when PH supplied medical records that have not yet been uploaded to the pet's policy.
What is Create a CI for medical records?
Taxes are eligible in these states under APIC and IAIC policies.
What are California, Nebraska, and Kentucky?
The denial reason code for a dental cleaning where PH lacks a wellness rider.
What is 245?
Fortiflora SA
What is formulary?
(Active Ingredient: Psyllium Husk)
The medical code for when an invoice contains a TAMU GI Panel and an abdominal ultrasound.
What is Undiagnosed GI Condition?
What is purple?
The correct procedure for when a 4dx test under Wellness is submitted, but one day later, another claim is submitted for an Rx of Doxycycline and PH is claiming Lyme Disease.
What is allow the 4dx Test under Lyme Disease?
The denial code for Visbiome given in-house.
What is 308 - Experimental Treatments?
Malacetic
What is Non-formulary?
(Malacetic ULTRA is formulary as it contains Keto/Hydro)
The medical code for when only diagnostic testing has been performed and no future claims have been submitted containing medication for said illness (I.E. LDDST testing, T4 panel).
What is Undiagnosed Illness - Chronic?
The correct outline for a final determination annotation.
What is Event, Invoice, POP, and Determination?
A red WARNING box that appears on a policy in TIA, or when a Provider is Red in the Relations screen. Not researching these can result in a potential discrepancy.
What is a POW?
The correct reason code for when a pre-existing condition is present within illness waiting period AND prior to policy.
What is Reason Code 208?
Explanation: 208 has been noted as a stronger denial than 207 in the past.
Optixcare Eye Lube w/ HA
What is formulary?
The correct med code for when PH is claiming lameness, but a future claim submitted shows an MPL repair was performed.
The number of attempts in which a phone call should be made to a Provider for information/substantiation/medical records?
What are two attempts?
The correct procedure when a euthanasia and cremation charge are bundled together.
What is pro-rate charge unless otherwise specified by provider?
The correct denial code for a Fecal / 4dx test with no Wellness rider.
What is Reason Code 244?
* Remember that Fecals and HW tests are denied as 244, not 243. 243 is used as a denial for vaccinations and other wellness items.
GS-441524
What is formulary?
(Metabolite of Remdesivir used to treat FIP).
The med code that is used for when the pet did not present or is not experiencing any clinical symptoms and there are no incidental findings warranting tx/diagnosis.
What is Healthy Pet?
The correct Provider for when only a pharmacy slip is provided and no indication of prescribing provider (I.E. Costco pharmacy receipt).
What is Vet Not Listed?
How medications should be coded if policy does not contain a Take Home Rx rider
What is TRX?