Claims Inquiry Web
Claim # 24299B1000154241
Was this payment made via EFT or paper check?
EFT
True or False: EFTs generated by Moda will have the Current Status "EFT Created"
True
What does claim status "02" mean?
Accepted; Batch Completed
Where is the first place we should look to see if prior authorization is required?
The Focus Chart
Claim # 242554109300
What was the allowed amount and paid amount for this claim?
$113.58 Allowed
$102.22 Paid
Who sent the payment out when the current status is "EFT Transmitted?"
Zelis
What does claim status "11" mean?
Pended; Awaiting Batch
What is the Part B deductible for 2026?
$283
Claim # 243205667100
Who is the provider for this claim and what is their specialty?
Chelsie Hutson
Licensed Mental Health Counselor
Which P&P covers Payments and Recoveries?
MED2710 - Researching Payments and Recoveries
If a claim denies with a Clinical Edit denial, can we read the denial to the provider?
Yes
How many practitioners practice at "Provider Group" P00001300404?
3
Claim # 251142952700
Why was no payment issued for this claim?
Capitation Applied
In the Payment Application - pull up Payment Reference ID:
2021123110500489. How many claims are listed under the "Recovery Detail" tab?
2
If an INN claim processed OON, can we send the claim back for adjustment?
Yes
Is this a funded pairing?
CPT: 40650
DX: K14.0
No - Codes pair on line 563 which is Below the Line of coverage (470.)
Claim # 242990002500
What was the total bulk amount this payment was for and what was the EFT number?
$116,119.49
24299B1000154241
Search the Payment Application for Check #1301343 with a date span of 01/01/2024-01/31/2024.
What is amount of this check that was paid out?
$297.60
What should you do if you see the denial:
84M - DMAP Registration Required for Payment
Obtain the NPIs that were included on the claim and verify them in MMIS.
When can Oregon Community Supplement members add a Vision and Hearing Rider to their policy?
During the annual renewal period (11/30 — 12/31).
Application must be post-marked before January 1st.