Auto Audit
Auto Audit is a claims review software for these types of claims.
Physician Claims
COB stands for
Coordination of Benefits
For claim status calls, make sure to attach the claim screen here.
Components
3 different payment methods WebTPA uses
Check, Virtual Credit Card (VCC) and Electronic Funds Transfer (EFT)
CPT code ranges 10040 TO 69979
Surgery
Customized auto audit rules can be found in this section of the benefit grid.
2A
We only coordinate with this type of health plans.
Group Health Plans
The caller needs to provide this information when requesting claim status.
Date of Service, Billed Amount, or claim number
Payment vendor uses an “Alt Pay Reference #"
Redcard
When a provider bills you for the difference between the provider's charge and the allowed amount.
Balance Billing
These are the 3 different line types used by Auto Audit.
Supporting, Corrected, Original
If both parents have group health plans, one with the birthday rule and one with the gender rule, this rule determines primary coverage.
Gender rule
A provider calls to inquire about member benefits. Verify this information first.
Network participation.
Payment method(s) will list a token number
VCC and EFT
POS code 12
Home
This EOB remark means the amount was already paid and is being restored to the accumulators.
FADJOFFSET
The difference between what we would have paid as primary and what we payed as secondary insurance goes in this field
COB Sav
A provider calls for benefits for urgent care services. Refer to this section of the benefit grid.
Section 13
We must receive these two items if the provider did not receive payment due to an address change.
Corrected claim and W-9
Pre-certs can be located by clicking this button in iii:PUT
Referrals
The status of the system generated letter line until the refund is received from the provider.
FADJ FC ACCUM
According to standard coordination of benefits, secondary insurance can pay the balance up to
The amount it normally would have paid if it was the primary
On claim status notes, you only need to complete the standard note template up to this point
Effective Date
The reference number you would you give to a no pay provider
N/A
This type of network will have providers and fee schedules loaded in iii:PUT.
“Partially-loaded" Network