Claims Updates

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Across
  1. 2. If your high dollar claim does not have a net reimbursement of over $6,000 and you do not see a pop-up stating the claim will be referred, you do not need to include high dollar __________.
  2. 4. If the policy lacks a wellness rider and the invoice is for a ______ cleaning, you will deny associated line items/fees as 245.
  3. 5. If the policy lacks a wellness rider and the invoice contains a fecal test or _______ test, you will deny those specific line items as 244.
  4. 7. The referral process change will no longer refer claims that are less than $6,000 after co-insurance and ______.
  5. 8. We added ______ Light Therapy and Phovia Blue Light Therapy to the Rehab Matrix to note that they should be denied as NCM (225).
  6. 10. If the policyholder is stationed at a ______ base overseas, the treating veterinarian must also be on the _______ base.
Down
  1. 1. For any high-dollar claims with a net reimbursement of $10,000 or more, a verbal __________ must be made following the protocol on high dollar claims.
  2. 3. Librela is an injectable and FDA approved drug for __________, and therefore is a covered medication in house. At this time it will be denied as 222 if sent home (until our 2024 formulary is updated).
  3. 6. All mortality services must be performed within policy span terms to be eligible for reimbursement on _____ policies.
  4. 9. If the policy has _________ Wellness rider, but lacks the Best Wellness rider, and the invoice is for Spay/Neuter/Teeth Cleaning, you will deny related fees as 375.