EPIC
Red liability bucket meaning
What is a denial or variance
The payor wants ________ when they request COB?
What is Coordination's of Benefits. Other insurance information.
Remit code 96
What is not covered?
Are MUE and NCCI denials/variances the same?
What is no
This remit code describes: This services may be covered by another insurance as per COB
Remit code 22
Resolve unbalanced paid claims using _______________
What is the 5 Whys?
The Birthday rule is _______________
Insurance COB based on parent's birthday.
Remit Code 119
What is benefits exhausted?
MUE stand is ______________
Medically Unlikely Edits Claim charges denied for exceeding units
This remit code describes: Charges are covered by a capitation agreement/ managed care plan".
Remit code 24
Billing indicator used when timely filing is not on the collection team
1030-Beyond timely filing
Medicaid and CMO pays Inpatient Claim and Outpatient claims based on ________ and _______.
What is IP-DRG (diagnosis related group)
What is OP -Ratio cost to charges % and Fee schedule
Remit code 227
What is Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.
7038 adjustment code is used for ____________
NCCI and Bundling
This remit code describes: The benefit for this service is included in the payment or allowance for another service/procedure that has already been adjudicated".
Remit code 97
The DMA-520 claim status letter in MMIS is found _______________
What is report letters ?
Correct billing indicator when account balance is NRP untimely?
4355538 NRP untimely
PX is short for in denial a denial reason code?
Procedure Code
NCCI is ________________
National Correct Coding Initiative Edits. Procedure cannot be billed with other Procedure billed on the same day- (Unbundled)
Services rendered prior to health care coverage. Expenses incurred after coverage terminated.
What remit cods
What are 26 and 27?
Unprocessed charges in the Prebilled Bucket are ____________________
What are late charges or credits
Percentage of charges Medicaid pays for Egleston Hughes or Scottish.
EG-23.7186%
HS--16.893%
SR-25.8443%
Remit code 11
What is the "Dx Code is in-consistent with the Px code billed".
Leadership's least favorite adjustment
What is 8026 Timely Filing
Denial leadership like the least
Denial code - 29 Time filing limit to submit the claim