IPAT Provider Selection Timely Filing
What is Explanation (EX) code 034
Claim Level bypass Auth Override code if claim is receiving the UMAE warning message
What is DBMR
Title of the return note from DBM
What is 180 calendar days
Claim submission filing limits for Participating providers unless contract lists a longer exception
What is 025 - DOS matched
025 - DOS matched
Appropriate EX code after you select the line item to apply the authorization to from the drop-down box that corresponds with the matching DOS of the authorization
What is INCF Incorrect Claim Form
Warning error received when the current provider selected should not be selected
Medicare: Providers must submit within three years from the paid date of the EOB or the date on the letter.
True or False
Medicare: Providers must submit within 90 calendar days from the paid date of the EOB or the date on the letter
What is Review the authorization in ICUE
First thing you should do if claim is returning the IPBL with the UMRV warning message
What is Place of service address
This is a required match when multiple provider have the same billing/remit address
What are maternity, inpatient, hospice, skilled nursing facility types of claims.
These types of claims, when billing a date range that cannot be split
What is DS status
Match UM Authorization should be in this status if you are Refer to the Emergency Billed SOP for processing
What are
•Change the provider ID to UNKNOWN in the Provider ID field.
•Add a claim note stating provider is not on file.
•Pend the claim in Facets CSP to DBMP.
These are the steps when a matching group is not found...
What is XX7
Providers submit claims with this Type of Bill Frequency to be considered a corrected claim
What is 1.00
Appropriate amount for Value Code 80 if the From and Through dates are the same
What is INPS warning message
This warning message appears on any claim where a 5XX group record is selected
What is Universal EDI acceptance code A1:19
This 4 digit Universal EDI code is listed on an Electronic claims Clearinghouse Acknowledgement Report when claim is accepted

Claims Ops

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