Claims
The process used when the provider is requesting a copy of a non-adjustment letter but there is NOT one attached to the SF.
What is sending an adjustment form with the provider's fax number to have a letter loaded?
Action required if a provider requests a copy of their denial letter for a TN Medicaid authorization
What is request a copy of the letter via the SMERT sharepoint?
The form required when a claim is in Pending/11 status past 30 days with a note stating ACL. (General, Adjustment, Email, etc.)
What is adjustment form?
TN DSNP auth requirements for code J9151 and dx C88.2
What is authorization is not required?
The length of TAT for a claim in a PCAD/PCAC claim hold.
What is up to 60 days?
Authorization requirements for G9008 for an in network behavioral health provider
What is authorization is required
The TAT for optuminsight claims after records are submitted
What is 30 calendar days to review the records and 15 additional calendar days to have the claim reprocessed?
Authorization requirements for 50590 done in the member's home for an in network provider
What is no authorization required?
The TN Medicaid timely filing limit for a corrected claim (a replacement of a previously submitted claim such as changes to charges, DOS, etc)
What is the later of 120 days from DOS or 120 days from denial
The subcategory used for speech therapy done in the home
What is home health?