16: Claim/service lacks information or has submission/billing error(s)
On Call Scenario:
Claim denied as additional information
requested from provider
↓
May I get the denial date?
↓
What kind of documents have you
requested from provider?
↓
What is the Fax# or Mailing address
to send the document?
↓
How much is the time limit to send the document?
↓
May I have the claim# & call ref#?
Important Note:
Claim denied as additional information
requested from provider
↓
May I get the denial date?
↓
What kind of documents have you
requested from provider?
↓
What is the Fax# or Mailing address
to send the document?
↓
How much is the time limit to send the document?
↓
May I have the claim# & call ref#?
Important Note:
- If requested documents are available to you then send it to insurance or ask the client if documents are not available.
- Calculate the time limit from the denial date, if it is not crossed then send the document, or else write off the claim if the time limit is crossed.
- Sometimes the client wants us to send the document even if the time limit is crossed, so work accordingly.
- Always check the remark code given with the denial reason, sometimes it provides the exact reason for denial that could differ. So follow the AR scenario tool to work the exact denial.
Prepare Notes:
Source of Status:
Clearing House Comment (Please make the changes if required):
Insurance Name:
Clearing House Name:
Insurance Phone#:
Rep Name:
Website Name:
Denial Date:
Requested Documents:
Mode of Submission:
Fax Number:
Mailing Address:
Website Link:
Time Limit:
Additional Comment:
Claim Number:
Call Reference#
Action:
In the below box, final notes will be displayed once you click on Submit button and this box is editable, so you can make the changes as per the requirement
Note: We are not saving your inputs in the backend.
Good
ReplyDeleteW9 form
ReplyDeleteGot a denial of N34 with CO 16
ReplyDeleteN34 - Incorrect claim form/format for this service.
DeleteAs per the denial description of N34, you can check if the claim is billed on the correct form with the correct format or not. If everything looks correct then it would be good to call the insurance and confirm with insurance rep.
denial co16 with remark code N254
ReplyDeleteA possible reason for this remark code could be the missing taxonomy code of the rendering provider on the claim form. But, you will have to call the insurance and confirm the exact reason.
DeleteDenial received CO-16 with remark code N56 How to tackle that?
ReplyDeletePlease refer the below post,
Deletehttps://www.arlearningonline.com/2019/12/181-procedure-code-was-invalid-on-date.html
like wise you guys created this ar scenario how about hospital billing and details of ub for denial or flow chart of process?
ReplyDeleteCO-16 WITH N29?
ReplyDeleteN29 states MISSING DOCUMENTATION / ORDERS / NOTES/SUMMARY / REPORT / CHART
DeleteYou can follow above scenario to work on this denial.
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ReplyDelete