SCREEN/TABS
under which screen do we get NDC units ?
ds popup --- f8 screen
Which popup gives us ambulance pick up and drop zip ?
DS Popup
provider submitted corrected claim with bill type 7 , no changes detected ,but when checked claim form of corrected claim ,we see changes in diag code and procedure code .what next ?
adjust the original claim as per claim form of CC
what is DME ?
durable medical equipments. its like wheelchair , walking stick , walking stand , etc ... additional equip used for treatments
sccf and dcn has how many digits . elabrate
sccf :17 , 1-3 plan code;4-7 century;8-15 julian date 11-17 sequence
dcn - 11 digits , 1st 2 - year ; 3-5 julian ; 6 7 - camera reels ; last 4 - sequence
under which tab do we get standalone pricing ?
search---pricing
When we adjust the claim for cob , what is the reason codes used ?
S05 & 283
Claim was submitted as on 12/15/2023 and the dos of the claim is 12/12/2023. The filing limit of the claim is 180 days . Please advise if the denial is correct ?
No. denial is incorrect and the claim is within
what is procedure code , diag code and modifier
proc code is a code that tells us what services what given ; diag code is a code that tells us what is the disease ; modifier is a code that gives us additional infor on the treatment
claim is deneid for 0010 , what is the next step ?
chk for claims after dos , if we dont have any claims after dos, then we will chk for term date in b2 and respond back
under which tab do we get clinical editing denials ?
clinical editing
when is asking for check details or bulk payment details ? which application do we look into ?
check inquiry
claim has NDC edits 9J ,9G edits . when checked claim form , we have NDC codes . what next ?
adjust the claim with available ndc codes in claim form with 248 and s1o
what is the indicator for non par providers
NN and DN
claim is denied for 0706 , no claims after dos .what next ?
raise gi 105 for streamline adjustment
under which screen do we get reference claim for IH denial ?
IH popup ---f5 screen
claim has changes in patient name , when compared to corrected claim. what is the workflow ?
void the original claim with 233 and f1n . and once void is complete , process the corrected claim
claim is denied for cx denial and the reference claim is denied as duplicate . what next ?
chk the freq of that claim . If freq 7 compare for changes , or if frq 1 , still we will adjust original claim , since any 1 claim shud be paid
what is the revenue code for range for well baby and sick baby ?
well baby - 170 - 171
sick baby - 172 , 173 , 174
medical records was attached as on 4/24/2024 . adjusted df posted as paid . what do we respond ?
chk if the claim is paid correctly and repsond that claim is paid
under which tab do we get mp popup pricing ?
claim data ---- pricing
claim denied for benefit and provider submitted appeal . Its been 28 days , and we have not received a response from HP . what should we do ?
raise a gi 325 asking determination
Claim is to be paid with $ 150.00 , but paid with $ 130.00 and $20.00 taken towards copay. provider is telling copay is not applicable . Please advise what to do
raise a gi 152 and ask Home plan
what is land ambulance / air / water ambulance pos ?
41 and 42
claim sccf has 172 reason code posted . The 172 record in b2 has another sccf # posted and that claim is paid as well , what next ?
raise a gi 175 asking status of this claim