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:

• 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:

* Call Website EOB System

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 Mail Website

Fax Number:

*

Mailing Address:

*

Website Link:

*

Time Limit:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Need client assistance Need to submit an appeal Requested document sent Adjusted off the claim



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