Locating Claims
This is located on ISET at the top between benefits and provider search
What is the claims tab?
This Colum tells if claim is INN or OON
What is the Benefit Level
We can access the claim form from this tab in ISET
What is the summary?
Where can you locate CPT/HCPCS/Procedure Codes
What is the Service Line Subtab?
You can search by these 2 options
What is subject or claim number?
This tab shows how the claim was paid out
What is the synopsis tab?
This advocacy can help you explain to member what information is needed before submitting a OON claim
What is claims advocacy?
In this box on the claim image you will find CPT codes, DOS and charge
What is box 24?
You can learn this from researching CPT codes.
What is the service/procedure performed?
To narrow down the search you use this
What is date range?
This tab tells the story of the claim
What is the service line
This document is required if OON provider is not loaded in our system
What is a W9 form?
In this box you can find the diagnosis
What is box 21?
One resource where you can find CPT code definition and type of benefit that applies.
What is Knowledge Library? (KL)
To look claims up by provider you use this search option
What is the tax ID search?
Here you can locate the type of service (general illness, Routine)
What is the line level cause
OON claims are paid directly to this person
What is the member?
In this box you can find the patients name, relationship and DOB
What is box 2?
This is where you can find diagnosis codes
What is the summary tab?
This number is used to pull up a claim
What is a claim number?
This is where you can view members Explanation of benefits (EOB)
What is the summary tab?
To determine how OON claims are reimbursed based on employer guidelines you would go here.
What is AVA OON reimbursement section?
This box is where you can see the billing providers name, address, phone and tax ID and NPI number
What is box 11?
This is what you can learn by researching diagnosis codes
Why did they need the service?