20: This injury/illness is covered by the liability carrier

On Call Scenario:

                                                     Claim denied as This injury/illness
                                                       is covered by the liability carrier
                                                                             ↓
                                                           May I get the denial date?
                                                                             ↓
                                                        Could you please provide the 
                                                             liability carrier details?
                                                                             ↓
                                                           Does rep have the details?
                                                         ↙                                          ↘
                                                   Yes                                                No
                                               ↙                                                           ↘
               What is the name, policy id, payer id &                      May I have the claim# 
                  mailing address of liability carrier?                                 & call ref#?

                                           ↓

                   May I have the claim# & call ref#?

Important Note:

• If the rep does not have liability carrier details then check in the system if there is any liability insurance available or patient payment history has any liability insurance as primary, if yes then resubmit the claim to that payer or else release the claim to the patient if liability insurance information is not available.
• You can also check the payer web portal to get liability insurance details if access is available.
• When the rep provides all the details of the liability carrier then you can update that insurance as primary and resubmit the claim to primary insurance. Do not keep commercial payer as secondary insurance.
• Medicare can be kept as secondary insurance and when the liability carrier leaves the balance as patient responsibility then bill to medicare after updating the MSP code.

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:

*

Did rep have the liability carrier information?/Is liability carrier information available?:

* Yes No

Name of the liability carrier:

*

What are the other infomration available/provided by rep:

* Policy ID Policy ID and Payer ID Policy ID and Mailing Address Payer ID and Mailing Address Policy ID, Payer ID and Mailing Address None

Policy ID:

*

Payer ID:

*

Claim Mailing Address:

*

Additional Comment:

Claim Number:

*

Call Reference#

*

Action:

* Claim released to patient Updated the liability carrier as primary and resubmitted the claim Need client assistance Need to allow more time



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