EDITS
Which edit indicates incorrect DME filing
AND , RANDME
Which popup gives us Billing provider NPI?
DS Popup
provider submitted corrected claim with bill type 7 , but no changes , what is the correct wf ?
respond back stating no changes found in claim , but once chk claim form
under which tab do we get the documents mlh # of a claim ?
attachments
claim is denied for 1083 we have rekeyed claim which is also denied for 1083. what do we do ?
raise a gi 152 n ask which is the correct prefix
Which bill type indicates that this is a void claim ?
8
When we adjust the claim for corrected claim , what is the reason codes used ?
S1N AND 287
Claim was submitted as on 7/15/2024 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 ?
yes , beyond
under which tab do we get check related details in ciw ?
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
Which edit indicates HIT services ?
Provider submitted bill type 8 claim , advise what action to be taken ?
find the original claim ( ds popup & claim form ) and void the original claim with 233 and f1n
Claim is denied upfront for PPRU. medical records are submitted. What next ?
rekey a claim and route for ppru dept for review . 1st check for rekeyed claim if any .
Under which tab do we get par/non par status of the provider ?
under claim header tab
claim is denied for 0706 , what next ?
chk for hist claim after dos . if we hv or dont have mention as per and raise gi 105
Which edits indicates missing REFERING PROVIDER / REFERING PROVIDER LOCATION CORRECTION
ANL
when claim is underpaid , correct reason codes to be used if any ?
adjust the claim using 248 and s10
When claims are denied upfront without sccf , in dp poup we have claim that matched the billed charges ?
check if that claim details are matching to our claim , if all are matching , consider that claim and take action on that claim
which tab provides us with sf df rf information ?
b2 data
medical records was attached as on 4/24/2024 . Till date no response , what do we do ?
check if the claim is paid . If not chk for adjusted df or a new df . If nothing , raise 175 gi
Which stop edit indicates ppru route, and timely filing denial ?
HCM and 590
mention the popups in which we get additional diag codes ?
PD and HP popup
Claim is to be paid with $ 150.00 , but paid with $ 130.00 and $20.00 taken towards copay. whats the correct response ?
claim is priced correctly , respond same
Under which tab do we update comments ?
notes
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