Claims by Mobile

3. indicated with a POS code of 32
5. a requirement that may apply for service, items, or medications to ensure medical necessity
8. when reviewing member history tab, make sure member was ______ during DOS
9. claim is in process and is in pending status
10. any bill for service will come directly from here
13. should be rebilled with valid code
15. payments are processed by finance on a monthly basis
16. uses status code A and may have been previously denied in error
18. used to ensure member was billed correctly
21. will show P if provider is participating or N if not
22. document that provides a listing of all processed claims and services received in previous months
24. confirming the member was active during DOS
25. utilize DOS or 'this' to narrow down claim search
26. do not escalate claims submitted by OON here
27. means charges were allowed
28. there is a reversal on this claim

1. to be transferred or coordinated with the appropriate vendor
2. claim is in a stage between posted and unposted
4. three words describing members cost-share that should be paid directly to provider
5. claim completed being processed and EOB was sent
6. 2 words indicating a complete listing of fees used by Medicare/Medicaid to pay providers and suppliers
7. this would be offered if a member disagrees with the resolution
11. request for payment submitted by a provider
12. claim processed and is awaiting check run (up to 30 days)
14. do this when you don't feel you have all of the information needed
17. claim is denied due to not meeting Medicare coding and billing guidelines
19. status code I and is only found in Institutional Claims
20. charges were reversed
23. an explanation of benefits is not a ______