Links
This link is used when requesting a claim to be sent to the insurance company.
What is "RB - Rebill"?
Batch #50200 would be found in _____, while Batch# 80200 would be found in _____.
What is "IPscan & HealthLogic"?
This is the Payer Issue Code we would use if we did not receive authorization for any of our dates of service.
What is "NIA - No Initial Auth"?
This activity code is used when requesting an adjustment.
What is "597"?
This link is used to update Financial Class and add/remove PICs.
What is "CD-Claims Data Entry"?
This is where you could review previous contracted rates.
What is "HSM - Hospital System Maintenance"?
This is the Level 2 PIC we would utilize if we needed to obtain authorization from the facility.
What is "FUND"?
This is the status code for requesting a small balance true-up.
What is "512"?
This link is used to review the batch information for payments received.
What is "PA- Payments & Adjustments"?
This is the total amount that the health insurance company believes the hospital should be paid for services provided.
What is "Allowed Amount"?
We would use the Payer Issue Code LTPT for this reason.
What would be "When we send a coordination of benefits letter to the patient"?
True or False?
Below is an example of the correct format when requesting an adjustment.
***B1 X407 $ 5.75 CY01/22/24***
What is "False"?
The VI is used to check this important status for GM encounters.
What is "QMB"?
This is the 2% Federal Reduction that applies to Medicare and Medicare Advantage plans.
What is "SEQ - Sequestration"?
This is the Payer Issue Code utilized when the insurance pays at a previous contracted rate, which results in a short payment.
What is Level 1 PIC - CIRU?
These T-Codes would be used for the following inpatient scenario:
INS PD $27,787.15 MATCHES CG TERMS LO 100% BC OR 95% CMG, CMG IS LO AT $30,244.24 PER EOB SEQ $567.08 PR $1,890.00. ADDED ALERT MESSAGE: PER VI, PT NOT QMB, CHANGED FC TO S2, REMOVED PICS, REQ ADJ FOR SEQ $567.08 AND SMALL BALANCE T/U $0.01. ***B1 ____ $567.08 CY10/12/2023***B1 ____ $0.01 CY10/12/2023***
What is "X418 & X421"?
The PI link is used to check these 3 items that can NOT be found on the main Patcom screen.
What is
"1. CMG, Length of Stay, Accommodation Code"?
These are the next 3 action steps after primary has paid correctly per contract and the assigned patient responsibility is already in the secondary bucket.
What is "Update FC, Request Rebill to Secondary Insurance, and Attach Prime EOB to Rebill Attachment Portal"?
This is the PIC utilized when the patient's insurance denied stating that their coverage is no longer active.
What is "COTM"?
This is the T-Code & Status used to submit a debit balance write-off due to Humana (Financial Class is GA) denying for no authorization.
What is "W444 & 500"?