Claims by Mobile

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Across
  1. 3. indicated with a POS code of 32
  2. 5. a requirement that may apply for service, items, or medications to ensure medical necessity
  3. 8. when reviewing member history tab, make sure member was ______ during DOS
  4. 9. claim is in process and is in pending status
  5. 10. any bill for service will come directly from here
  6. 13. should be rebilled with valid code
  7. 15. payments are processed by finance on a monthly basis
  8. 16. uses status code A and may have been previously denied in error
  9. 18. used to ensure member was billed correctly
  10. 21. will show P if provider is participating or N if not
  11. 22. document that provides a listing of all processed claims and services received in previous months
  12. 24. confirming the member was active during DOS
  13. 25. utilize DOS or 'this' to narrow down claim search
  14. 26. do not escalate claims submitted by OON here
  15. 27. means charges were allowed
  16. 28. there is a reversal on this claim
Down
  1. 1. to be transferred or coordinated with the appropriate vendor
  2. 2. claim is in a stage between posted and unposted
  3. 4. three words describing members cost-share that should be paid directly to provider
  4. 5. claim completed being processed and EOB was sent
  5. 6. 2 words indicating a complete listing of fees used by Medicare/Medicaid to pay providers and suppliers
  6. 7. this would be offered if a member disagrees with the resolution
  7. 11. request for payment submitted by a provider
  8. 12. claim processed and is awaiting check run (up to 30 days)
  9. 14. do this when you don't feel you have all of the information needed
  10. 17. claim is denied due to not meeting Medicare coding and billing guidelines
  11. 19. status code I and is only found in Institutional Claims
  12. 20. charges were reversed
  13. 23. an explanation of benefits is not a ______