Patient can not be identified

Verify with Pt’s name, DOB, SSN#, Address

FOUND NOT FOUND

Verify with Subscriber's name ,DOB,SSN#

FOUND NOT FOUND

Get the correct member ID# ( update the correct ID# in system)
Call-ref#
check whether any claim found for the DOS
YE NO PC
S verify if the patient is having any other active insurance in
software
collect the status of claim (it Get the patient eligibility Yes No
may be any scenario)
verify eligibility , if policy is active , bill the patient (or) escalate to
Get the Timely filing Limit file the claim according to COB client
claim# & call-ref#

Get the Payer ID#,

PC
Follow the scenario post call
Mailing address (or)
action and change the ID# in the Fax#
system
call-
ref#
PC
Update the correct ID # in system and
Resubmit the claim with correct member
ID#
 1. Could you please try to find the member with Name, DOB, address ?
2. May I have the correct member id#?
3. Could you please verify whether any claim is available for the DOS (provide the DOS and billed amount)?
4. May I have the clm status?
5. May I have the pt’s eligibility details and TFL and address or payor id# to re-submit the claim?
6. May I have the call-ref# ?
------------------------------------------------------------------------------------------------------------------------------------------------------------------
---
1. Could you please try to find the member with SSN#?
2. May I have the correct member id#?
3. Could you please verify whether any claim is available for the DOS (provide the DOS and billed amount)?
4. May I have the clm status?
5. May I have the pt’s eligibility details and TFL and address or payor id# to re-submit the claim?
6. May I have the call-ref# ?
------------------------------------------------------------------------------------------------------------------------------------------------------------------
1. Could you please try to find the patient with subscriber’s Name, DOB, address ?
2. May I have the correct member id#?
3. Could you please verify whether any claim is available for the DOS (provide the DOS and billed amount)?
4. May I have the clm status?
5. May I have the pt’s eligibility details and TFL and address or payor id# to re-submit the claim?
6. May I have the call-ref# ?
• Notes :

Called Aetna @ 800 458 5874 SW Mark said unable to identify the
pt with the given ID#, tried to pull the member with the name,
DOB ,SSN# 874 52 4785 and finally located the pt. rep said the
correct ID# W7854122541 and its been updated in the system.
Checked for the claim status for the DOS 01/10/2020 however
there was no clm found for the DOS. TFL 120 days from DOS. Payor
ID# Aed47 , therefore resubmitted the claim with correct ID#.
Call-ref# Mark02/20/2020