VA
What unique identifier does the VA use as the patient ID number?
The veteran’s Social Security number (9 digits).
What is the recommended follow-up time after sending a secure message to Anthem?
10–12 days.
When should a claim be routed to the credentialing department?
Only after payer confirms provider is not credentialed.
What does CO-45 indicate
Contractual adjustment—amount not payable under the plan.
What is the default follow-up time in the system?
30 days
When submitting a corrected claim to VA, what resubmission code should be used in Box 22 of the claim form?
7, which indicates a corrected claim.
What should be included in the note when contacting Anthem about a duplicate denial?
state it was a corrected claim and include the Availity reference number (ICN).
What documents should be included in a reconsideration?
Appeal form, EOB, and relevant medical records.
What does OA-23 indicate?
The primary insurance paid more than Medicaid
Where can you find payer control numbers in Cerner?
In the insurance transactions tab, by configuring the layout.
What happens if a veteran does not obtain prior authorization for specialty services through the VA?
The VA will not pay for the service. They do not allow retroactive authorizations.
What tool was suggested for contacting Anthem securely?
Availity secure messaging.
If a claim was denied for coverage termination and the patient has no active plan, what is the next step?
Bill the patient directly.
What remark code indicates another insurance may be primary?
CO22.
Where can you find the insurance's claim number in RevCycle?
Under Insurance Transactions tab in the payer control number column.
What prefix do VA authorization numbers typically start with?
“VA”, followed by digits.
How long should you allow for UHC to reprocess the claim after submitting proof?
15 to 30 days
What should you include in a note after sending a secure message to the payer?
The reference number (ICN) and a brief explanation of the action taken.
What does Remark code CO197 indicate?
Provider not certified for the professional component of the service.
Where do you check for claim details like CPT and dates of service?
The Charges tab.
What two common issues cause most VA Optum claim denials?
What document ID should you record after UHC chat interaction?
The document ID number provided by UHC for the reprocessing request.
How do you handle incorrect member ID on a claim?
If it’s a facility claim, route to registration; if it’s a clinic claim and near timely filing, correct and rebuild the claim.
What is the difference between CO 96 and PR 96?
Where can you check for an authorization in the system?
In PowerChart under “Billing Authorizations” and also on the payer portal.