IPAT | Provider Selection | Timely Filing |
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What is Explanation (EX) code 034
Claim Level bypass Auth Override code if claim is receiving the UMAE warning message
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What is DBMR
Title of the return note from DBM
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What is 180 calendar days
Claim submission filing limits for Participating providers unless contract lists a longer exception
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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
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False
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
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What is Place of service address
This is a required match when multiple provider have the same billing/remit address
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What are maternity, inpatient, hospice, skilled nursing facility types of claims.
These types of claims, when billing a date range that cannot be split
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What is DS status
Match UM Authorization should be in this status if you are Refer to the Emergency Billed SOP for processing
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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...
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What is XX7
Providers submit claims with this Type of Bill Frequency to be considered a corrected claim
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What is 1.00
Appropriate amount for Value Code 80 if the From and Through dates are the same
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What is INPS warning message
This warning message appears on any claim where a 5XX group record is selected
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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
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