Rejected Claims
Rejected claim code 01 means?
"Member's DOB is missing or invalid"
Code Set Screen: Definitions of different codes displayed in Amisys.
"RF0200"
A "P" will be displayed after the LOB if the claim was submitted via?
"Paper"
What is the correct routing box in escalating a claim in OMNI 2?
"CNC_Claims_Escalations_WB"
When the ST column shows code "10,11,12" this means the claim is ?
"Paid"
If the rejection is "NDC or UPN is missing or invalid" the code is?
"A5"
Claims by Member Inquiry Screen: Allows you to search for all claims submitted on behalf of the member by using the member’s ID number.
"IQ1300"
An E will be displayed after the LOB if the claim was submitted via?
"Electronic"
In some cases, the claims examiner will void out the original processing of a claim and reprocess the new information under a new claim number.
"Reclass Claims (Corrected Claim)"
Under the ST column if the code is "90 and 91" this means the claim is ?
"VOIDED"
"Type of Bill or Place of Service is missing or invalid" the rejection code is?
"77"
Claim Summary Inquiry Screen: Allows to view claim information (for one claim) by using a specific claim number.
"IQ1200"
An 8 will be displayed after the LOB if?
"Claim was a Rekey Claim (Manually Entered)"
If the authorization number starts with IP it means?
"Inpatient Facility Authorization"
If the "Type" box on IQ1200 screen shows "M", this means the claim is?
"Professional Services Claim"
In order for an ambulance claim to be processed, the zip code for the point of pick-up is required. For Medicare claims the point of pickup zip code is required in what box for CMS 1500?
"Box 23"
Provider Affiliation Screen: Displays the provider’s timely filling limit, specialty, participation, effective date/term date, etc.
"PR0300"
A 5,6, or 7 will be displayed after the LOB if?
"Adjusted Claim due to a correction (Corrected Claim)"
To view the Received and Processed Dates, we have to access ______ screen.
"Service Dtl"
Check #/EFT Advice# Provides information regarding the check, if this column shows "0 Balance Check" this means?
Used to offset a negative amount on the provider's account
Rejection code C6 is?
Other health insurance fields 9, 9a, 9d, and 11d are missing appropriate data/ COB / Other Health Insurance
Eligibility Screen: Displays current and historical eligibility information for the member.
"IQ0800"
The day the claim was received is displayed by the Julian Calendar date listed on the claim number:
In the claim number below the claim was received on?
Claim Number: S019CXE1245
"January 19,2019"
Ex code ____ is always used to indicate an adjustment was made and to override our original processing.
"JU"
Check #/EFT Advice# Provides information regarding the check, if this column shows "NEG BAL" this means?
It's the claim that caused an overpayment