Payment Reconciliation
Total amount paid plus any patient responsibility, plus sequestration (if a MCR or MCR Adv acct), equals this...
What is "the Allowed Amount"?
The difference between what we bill for services and what will be contractually be paid becomes this...
What is a "Contractual Adjustment"?
This code is placed on an account to identify specific payer issues, track trends and for escalation purposes...
What is "a UFC code"?
This is an EOB with a virtual credit card attached sent in as payment from some insurance companies...
What is "a Quick Remit"?
The ARA must obtain these three pieces of information from the payer before submitting the appeal request...
What are "the Appeals Mailing Address, Timely Filing Guidelines and any forms required by the payer"?
MCR and MCR Advantage are allowed an additional 2% reduction in what they pay, which is referred to as this...
What is "Sequestration"?
Adjustments that use a "W" T-Code are this kind of adjustment...
What is a "Write Off"?
There are this many levels of UFC codes...
What is "6"?
These EOBs do not have any payment attached and they have code that identify why charges were not covered...
What is a "Denial/Zero Pay"?
Any additional documents that are not actively available in PowerChart/DM View need to be uploaded using this...
What is "DM Capture"?
We are not allowed to bill MCR and MCR Advantage patients for copays, coinsurance or deductibles if they are this...
What is "QMB Eligible"?
Placing brackets around the adjustment amount indicates this...
What is "you are increasing the balance by this amount"?
This Level 2 UFC is used for a coordination of benefits issue...
What is "COBI"?
This portal is used for Payment Move Forms, Posting Errors or corrections on payments needed, Missing payments (only when insurance states payments were cashed...
What is "Cash Review"?
This form is often required when requesting an appeal...
What is "a Provider Appeal/Reconsideration Form"?
Use this tool to check what the contracted rate of reimbursement is for a specific payer...
What is the "Contract Grid Tool"?
The BP shown in the format here ***INS1234 X307 $(1000.00) BP03/05/2026***, stands for this...
What is "Billing Period"?
This level 3 UFC code is used when a facility update is needed...
What is "FUND"?
Allow this many business days for corrections to be made before placing a request for a posting error...
What is "3 business days"?
When submitting an appeal for a Medicare Advantage plan, this form may be required...
What is "a Waiver of Liability form"?
Use Millenium to review a patients QMB Eligibility under this tab...
What is "Insurance"?
An adjustment request for an amount over $10,000.00 requires this many levels of approval...
What is "3"?
When accounts need additional assistance from the facility or to notify it of any account issues that may have a a high financial impact, Their information is added here...
What is "the Action Item Log"?
Adjustment corrections will be made only if the error was made by this team...
What is "the Cash Team"?
If the reason for the appeal is because not all days of the stay were covered, we would submit this type of appeal...
What is "an Authorization Appeal"?