21: This injury/illness is the liability of the no-fault carrier

On Call Scenario:

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

             No-fault carrier/Auto insurance?

                                     ↓

             May I have the claim# & call ref#?

Important Note:

• If the rep does not have No-fault/Auto carrier details then check in the system if there is any Auto insurance available or patient payment history has any Auto insurance as primary, if yes then resubmit the claim to that payer or else release the claim to the patient if Auto insurance information is not available.
• You can also check the payer web portal to get the auto insurance details if access is available.
• When the rep provides all the details of the No-fault/Auto 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 No-fault/Auto 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 no-fault/auto insurance info?/Is no-fault/auto insurance info?:

* Yes No

Name of the no-fault/auto insurance:

*

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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