MOAT Status & Reason Codes

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Across
  1. 1. Special Grouping Selected claims will go to this status so that the claim will not go through the MRM process until the MRM comments are uploaded.
  2. 3. Technical Denial Medical Record requests open for greater than 90 days from the date of the original request. The full paid amount on the claim is set up for FR (Medical Records needed in order to repay the claim)
  3. 4. Medical Record Received
  4. 5. Low Error Rate (RC)
  5. 9. Appeal 3 Pended
  6. 11. Recon - Sent Back to Vendor
  7. 13. Appeals Modified - Send to FR
  8. 14. Assigned Claim is assigned to but not selected by the current vendor
  9. 16. Can't Tech Deny - Limitation(RC)
  10. 17. Technical Denial Reopened Medical Record was received post-technical denial. The technical denial FR is written off (or repaid if money was recouped)
  11. 19. FR request to cancel (RC)
  12. 20. No Findings Re-evaluation Assignment Claim is on an assignment file to be chosen from for re-evaluation
  13. 22. Valid overpayment too old to pursue (RC)
  14. 24. Cancel Loaded Claim Audit was cancelled after an FR was set up on the claim
  15. 25. Verify MRM request is complete(RC)
Down
  1. 2. Limitation per Contract (RC)
  2. 3. Timeframe Limitation with a Finding (RC)
  3. 6. Appeals Send To FR -Claims that were repriced for modified appeals that need to be sent to FR to be setup.
  4. 7. informational assignment
  5. 8. Loaded in FR Collections Audit complete with findings (Billing errors discovered). FR set up on the claim.
  6. 9. Appeal of claim level 1 completed - findings were overturned, no item set up
  7. 10. Past Timeframe (RC)
  8. 12. - Not selected by any vendor (RC)
  9. 15. No Findings Re-evaluation Completed There was a no finding found during re-evaluation or there is no re-evaluation done on that extract/audit type and a no find was loaded in the 1st pass.
  10. 16. FR Item Recoup Amt = 0 (RC)
  11. 18. Findings Reconciliation Finding Reconciliation (A billing error was found on the claim, but the recovery was not able to be setup automatically and will be setup manually)
  12. 21. AP2UN is Appeal is upheld, findings are valid, claim needs setup in FR. It flows to AFR nightly then AP2UL once the claim flows to FR for the setup.
  13. 23. Hold - Findings loaded • Where the user will be able to upload a finding on a claim in HOLD status, when it comes off HOLD the finding will be processed.
  14. 25. Won't Allow Vendors(RC)
  15. 26. Send to FR Collections Claims have been sent to Financial Recovery for Setup.