Knowledge/Skill
The New Name of Anthem Inc.
Elevance Health
This Edit fires when NDC code is missing, incorrect or invalid.
JCD 9Exx 9Fxx 9Gxx 9Hxx 9Jxx 9Lxx Edits
When Bypassing PAJ what is the standard Text?
Processing claim for PA/PAJ/IBL no adjustable history claims, processing as the original. AHxxxxx”.
Finalization code for Voided Claims
RCLMCO
Where do you find Queue code on CI&W?
Notes>Mainframe Claim Notes
How to Access COB on a Live claim?
Change N to Y in the COB field in Pac View 1
We usually end up making a CPS request with this type of edit
088 Edit
Standard text for DUP/Mailback to the Provider.
Please submit the requested information.
Reason codes for Void claims in WGS and Blue².
F1N and 233
Where do you find the length of stay or total days?
Claims Data>ITS Tab
Adjustment Sequence Number for Original Record
999
Working on PAJ edit on a Facility Claim, Patient's Date of birth is different on the original claim. Can we still proceed with the adjustment?
Yes
for 590 edit, what is the standard text if the professional claim is filed more than 90 days from the date of service and no history claim is on file?
Timely filing has not been met, no history information can be found. AHXXXXX
ANSI/ CAS Codes for Deductibles, Co-Insurance and Co-Pay
PR 1, PR 2 and PR 3
In CI&W, Pricing under Search tab. What is the button we click to automatically price the claim without updating it in the Pricing tab under Claims Data (MP pop up)
Apply Pricing
Queue Status of the claim when a CPS ticket was created.
06
This Soft edit disappears when the claim is opened in the Live Screen
HST edit
PPR Says Allow Zero on the entire claim. what is the standard text that we should add?
Claims admin add SF message U602 at claim level and remove SF message code 1002 at line level.
Action code when the claim was deleted with no letter sent.
RDELEX
CC-QQ-AA
Term used when provider submit claims with overcharging of services due to typo error or human error.
UPCODING/OVERCODING
This edit will fire on rekey claims that are manually rekeyed or sent to SourceCorp for rekeying.
REK Edit
For 6A and 6K edits, The procedure codes and Modifiers are matching with the WCF image and the D8 rule is present in the CI&W editing tab. what is the standard text for mailing back the claim to the provider?
Submit a new claim with the information requested. Modifier [modifier]. As combination invalid for CPT - [procedure code].
Queue Status is H000CR. what does this mean?
H000CR - The claim was routed to PPR. (it is still in PPR)
The City of India where Kalpana is located.
Hyderabad, India