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AR MANUAL

                                   ISSUES AND ACTIONS

Claim   not on file
        Claims mailing address
    ...
    Verify timely filing limit
        Fax number.
    •    May I have the denial date and the filing limit for this cla...
     Fax number
        EOB request.
        May I have the date this claim was denied?
        I have a referral # in...
      EOB request
         May I have the date this claim was denied?
         Could you please tell me which is correc...
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Medical Billing AR Manual

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US Health Care and Medical Billing Industry

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Medical Billing AR Manual

  1. 1. AR MANUAL ISSUES AND ACTIONS Claim not on file  Claims mailing address  Fax #  Whose attention the claim has to be faxed  Effective date  Timely filing period  Verify id and group #.  May I have the claims mailing address?  Could you please give me the fax # and can I go ahead and fax it your attention?  Is patient eligible for the DOS?  May I have the filing limit for this claim? Claim in process  Date of receipt of the claim  Processing time.  Can I have the date on which the claim was received?  How long would that take to process this claim? Claim forwarded to the payer from the pricing center  Date of forwarding of claim to the payer  Payer phone number.  Could you please tell me the date on which the claim was forwarded to the payer?  Can I know the phone number for the payer please? Claim paid  Check #  Check date  Paid amount  Allowed amount  Patient's responsibility  Write off  Pay to address  Cashed date  Could you please tell me the check # and check date?  How much was the allowed amount for the claim  Can you please tell me how much was paid for this DOS?  Are there any write off on this claim?  What would be patient’s responsibility?  Can you verify the pay to address for me please?  Was the check cashed? Claim paid to wrong address  Verify pay to address  Telephone appeal to update  W9 form  Cancelled check copy if cashed  If not, request for stop payment and reissue the check.  Could you verify the pay to address for me please?  Can you go ahead and update your records if I give you the correct pay to address for the provider over phone?  Could you please give me the fax # and can I go ahead and fax W9 form to your attention?  Please fax us a copy of the cancelled check if the check has already been cashed  Could you please put a stop payment for this check and reissue the check to the correct address? Claim denied for untimely filing  Date of denial  Re-filing and appealing address
  2. 2.  Verify timely filing limit  Fax number. • May I have the denial date and the filing limit for this claim? • Can I have the address where I need to appeal for this claim?  Could you please give me the fax # and can I go ahead and fax it to your attention? Claim denied for eligibility  Date of denial  Effective/ termination date of coverage  EOB request • May I have the denial date for this claim? • May I have the effective / termination date of patients policy?  Could you please fax / mail me a copy of the EOB Claim denied for non covered services  Date of denial  Details of the non covered service  Check if patient can be billed  EOB request. • May I have the denial date for this claim? • Could you please tell me the services that are not covered under this plan? • Can we go ahead and bill the patient for this claim?  Can I get a copy of this EOB faxed / mailed to me please? Claim denied for EOB from the primary insurance  Date of denial  Information on primary insurance if the rep has with their system  Fax number  May I have the date this claim was denied?  Would you be able to re-process this claim if I were to fax you the Primary EOB? Claim denied for cob  Date of denial  Information of the other insurance if they have on their file  EOB request  May I have the date this claim was denied?  Would you be able to tell me if the patient has any other Insurance?  Could you fax / mail me a copy of the EOB? Claim denied for capitation  Date of denial  If possible date of Capitated contract  Request for EOB • May I have the date this claim was denied? • May I have the date of capitated contract?  Could you fax / mail me a copy of the EOB? Claim denied for authorization number  Date of denial  Check if there is any auth in the software mentioned for the dos  Check if they have an auth on file for any hospital claim for the same dos  Fax number  EOB request. • May I have the date this claim was denied? • Could you please tell me if you see any authorization # for the same DOS for the hospital claim? • I have a authorization # in the system, could you re-process the claim if I give this number to you now? • Would you be able to re-process this claim if I were to fax you the claim with authorization number?  Could you fax / mail me a copy of the EOB? Claim denied for referral  Date of denial  Check if there is any referral on the software mentioned for the dos  Check if provider is participating
  3. 3.  Fax number  EOB request.  May I have the date this claim was denied?  I have a referral # in the system, could you re-process the claim if I give this number to you now?  Would you be able to re-process this claim if I were to fax you the claim with referral number?  Could you fax / mail me a copy of the EOB? Claim denied as bundled/ incidental/ inclusive  Date of denial  Major procedure to which it has been bundled  Can we appeal with medical notes  Fax number  EOB request.  May I have the date this claim was denied?  Could you please tell me to which major procedure the claim has been bundled to?  Can I have the address where I need to appeal for this claim?  Could you please give me the fax # and can I go ahead and fax it to your attention? Claim denied for referring physician  Date of denial  Ask if provider is the PCP  If not ask for PCP’s name and phone number  Insurance fax number  EOB request. • May I have the date this claim was denied? • Would you be able to reprocess this claim if I give you the referring physician’s name and UPIN #?  Can I have your fax number? Claim denied for incorrect provider  Date of denial  Correct provider info  Fax number  EOB request. • May I have the date this claim was denied? • I have the correct provider # in the system, could you re-process the claim if I give you this information?  Can I have your fax number please? Claim denied as primary paid maximum  Date of denial  Allowed amount  Verify the primary payment details  EOB request. • May I have the date this claim was denied? • May I know the allowed amount for this claim? • Could you please tell me how much did the primary paid on this claim?  Could you fax / mail me a copy of the EOB? Claim denied for wrong diagnosis  Date of denial  Correct diagnosis code  Fax number  EOB request. • May I have the date this claim was denied? • Could you please tell me which is correct diagnosis for this procedure? • Can I have your fax number please?  Could you fax / mail me a copy of the EOB? Claim denied for modifier  Date of denial  Correct modifier  Ask for fax number
  4. 4.  EOB request  May I have the date this claim was denied?  Could you please tell me which is correct modifier for this procedure?  Can I have your fax number please?  Could you fax / mail me a copy of the EOB? Claim denied for pre-existing condition  Date of denial  Pre-existing condition  EOB request  May I have the date this claim was denied?  Could you tell me the condition that was classified as pre-existing for this patient?  Could you fax / mail me a copy of the EOB? Claim denied as not medically necessary  Date of denial  Appeal with medical notes  Fax number  EOB request  May I have the date this claim was denied?  Can I go ahead and send the appeal with medical notes?  Can I have your fax number please?  Could you fax / mail me a copy of the EOB? Claim denied for untimely follow up  Appealing address  Verify timely follow up time  Fax number  May I have the date this claim was denied?  Can I go ahead and send the appeal with proof of timely follow up?  Could you tell me the follow up time for this claim?  Can I have your fax number please? Claim denied as duplicate  Date of denial  Primary dos to which the claim is denied as duplicate  Appeal with medical notes  Fax number. • May I have the date this claim was denied?  Can I have the details of the primary procedure to which claim is duplicated? • Can I go ahead and send the appeal with medical notes? • Can I have your fax number please? Claim denied as Offset  Date of denial, Offset dos details, Amount offset, EOB request • May I have the date this claim was denied?  Could you give the details of the DOS offset to?  How much was offset to? • Could you fax / mail me a copy of the EOB? Claim pending for additional information  Details of the information required  Fax number  Could you tell me the information required to process this claim?  May I have your fax number please? Claim processed towards patient's deductible  Processing date  Provider in or out of network  Break up of the benefits  EOB request.  May I know the date on which this claims was processed?  Is the provider out of network?  Could you please tell me how much was processed towards the deductible? • Could you fax / mail me a copy of the EOB? Claim paid to patient  Check if provider is participating  Payment details  EOB request.  May I know when was the claim paid to patient?  Can I know how much was paid to the patient?  Is the provider participating? Could you fax / mail me a copy of the EOB?

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