SOFTWARE TRAINING FORMAT

 SOFTWARES

1.E360 -VRCM COMAPANY

2.ECW-R1RCM ,INFINIX , ASCENT
3.NEXTGEN- R1RCM ,INFINIX , ASCENT
4.CPMS-R1RCM
5.CENTRICITY-OMEGA ,ASCENT ,R1RCM
6.INTERGY-INTEGRA
7.ALL SCRIPT-R1RCM ,ECLET
8.MD.ON-R1RCM
9.EPIC-R1RCM , VEE TECHNOLOGY

 CLEARING HOUSE
1.WAYSTAR
2.WELLSFARGO
3.TRIZETTO
4.ENTHRIVE
5.REVENUE MANAGER

 Waystar :
 Waystar it’s a third party application were we have to check the claim status
and check the EOB .
 In these application we have to check the patient eligibility.
 Waystar is a option to check whether it is claim not on file and is there any
rejection for the claim .
 In these waystar we have access to send the claim primary insurance to
secondary insurance ,and option to rebill the claim
 Waystar it’s also used to send the appeals to the insurance company.
 TRIZETTO:

 Trizetto it’s a third party application for the clearing house were have to
checked the claim status and EOB .
 In these application we have to check the patient eligibility.
 Trizetto is option to check the whether it is claim not on file and is there any
rejection for the claim.
 In these trizetto we are not able to send the claim to primary insurance to
secondary insurance and not able access to rebilled the claim.

 WELLSFARGO:

 Wellsfargo it’s a third party application were we have to check the only
payment information .
Example:-In our software the payment has been paid by the insurance company,
however the balance has been reflecting in the paid bucket .and we not received
any EOB in waystar ,wellsfargo application is option to check only for the
payment details.

 ENTHRIVE :

 Enthrive it’s a third party application were we have to check the claim status
and check the EOB .
 In these application were we have to check the patient eligibility.
 Enthrive is option to check the whether it is claim not on file and is there any
rejection for the claim .

 How to check the claim status in waystar:-

1.Copy the patient ACCOUNT number allocation sheet.
2.Open the waystar.
3.Select the practice address according to claim form box no.33 .
4.Seclect the claim processing option .
5.Click on the claims option.
6.Select the status bar into ALL.

7.Go to bottom of the page left side select the archieved bar into include
archieved.
8.Go to the transaction tab and select ALL option.
9. Go to the CLAIM NUMBER bar paste the encounter number and click on ENTER
button .
10.The automatically one page will be open in waystar and we able to seen the
claim whether it is paid or denied and rejected .
How to check the ELIGIBILITY in waystar:-

1.click on the ELIGIBILITY option in waystar home page .

2.select the payer name .
3.select the provider name .
4.Enter the DOS .
5.Enter the member ID, patient name ,and DOB.
6.Click on submit button .
7.Automatically one page will be open.

 In these page we are able to see ,patient EFFECTIVE date and TERM date .
 In these page we access to seen the patient last COB update .
 And other ACTIVE insurance details.
 PCP name and PCP phone# ,PCP mailing address.
 Patient annual DEDUCTIBLE ,and how much the patient met.

CALLING APPLICATIONS:

1.PULSE
2.I-BEAM
3.LIVEVOX
4.CISCO JABBER
5.SKYPE

 VPN:-
1.MOBILITY
2.NETMOTION

 INSURANCE MEMBER ID –PATTERNS.

1.Medicare- 1EG4TE5MK73 ALPHA NUMERIC.
2.COMMERCIAL-NUMERIC
3.BCBS – XYZ1234567-ALPHA NUMERIC
1234567XYZ-NUMERIC ALPHA
 123XYZ6789-ALPHA-NUMERIC-ALPHA

 SAMPLE INSURANCE CARD.

1.FRONT SIDE OF THE CARD. 2. BACK SIDE OF THE CARD.

 ALLOCATION PATTERN:
1. TL allocate the allocation sheet through mail in outlook .
2. TL allocate the allocation sheet through path folder.

 AFTER RECEIVED THE ALLOCATION SHEET.

1. First we have to sort the claims according same insurance company and
same patient .
2. After we work accordingly callable claims.
3. After complete the callable claims we go for the analyze claims.

 ALL DENIALS NOTES PATTERN WITH THE EOB .

 CLAIM DENIED FOR COVEREGE TERMINATED PR-27

POLICY IS ACTIVE REPROCESS NOTES.

1.DOS 04/20/2023 BA$532.22 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @BCBS CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 05/04/2023 AS THE POLICY INACTIVE FOR THE DOS,VERIFIED THE EFF-
01/01/2023 TO 12/31/2023 POLICY IS ACTIVE SO CALLED THE INS @123-456-7897 S/W LISA SENT BACK FOR
REPROCESS VERIFIED THE TAT# 30 TO 45 BUSSINESS DAYS THERFORE NEED TO ALLOW SOME MORE TIME TO
PROCESS THE CLAM ,CLAIM#3061173832 CALL#987654321

STATUS CODE:-INACTIVE COVEREGE

ACTION CODE:-REPROCESS THE CLAIM

POLICY IS INACTIVE NEED TO FORWARD SECONDARY ACTIVE INSURANCE.

2.DOS 04/20/2023 BA$532.22 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @BCBS CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 05/04/2023 AS THE POLICY INACTIVE FOR THE DOS,VERIFIED THE EFF-
01/01/2022 TO 12/31/2022 POLICY IS INACTIVE CHECKED OTHER ACTIVE ELG IN WAYSTAR ,PATIENT HAVE
@HUMANA VERIFIED THE ELG,EFF-01/01/2023 TO 12/31/2023 VERIFIED THE MAILING ADDRESS PO BOX 54623
ATLANTA GA ,9516 TFL-180 DAYS FROM DOS THERFORE CLAIM NEED TO BE FORWARD TO @HUMANA UNDER THE
CLAIM#3061173832

STATUS CODE:-INACTIVE COVERAGE

ACTION CODE:-REBILL TO SECONDARY

POLICY IS INACTIVE NO OTHER INSURANCE FOUND BILL TO PATIENT.

3.DOS 04/20/2023 BA$532.22 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @BCBS CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 05/04/2023 AS THE POLICY INACTIVE FOR THE DOS,VERIFIED THE EFF-
01/01/2022 TO 12/31/2022 POLICY IS INACTIVE NO OTHER ACTIVE INSURANCE FOUND ON PATIENT ACCOUNT
THERFORE TRANSFER THE BALANCE TO PATIENT UNDER THE CLAIM#3061173832
STATUS CODE:-INACTIVE COVEREGE

ACTION CODE:-BILL TO PATIENT

 CLAIM DENIED FOR TIMELY FILING LIMIT CO-29

CLAIM DENIED FOR THE TIMELY FILING LIMIT NO POTFL FOUND IN THE WAYSTAR.

1. DOS 07/28/2022 BA$1383.82 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @UHC CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 02/08/2023 AS THE TIMELY FILING LIMIT HAS BEEN EXPIRED VERIFIED THE
RECEIVED DATE -02/03/2023 VERIFIED THE TFL-90 DAYS FROM DOS NO POTFL FOUND IN THE WAYSTAR
THEREFORE NEED TO ADJUST THE BALANCE UNDER THE CLAIM#KLC7285483100

STATUS CODE:- TIMELY FILING LIMIT

ACTION CODE:-WRITE OFF

CLAIM DENIED FOR THE TIMELY FILING LIMIT INCORRECTLY .

2. DOS 07/28/2022 BA$1383.82 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @UHC CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 08/15/2022 AS THE TIMELY FILING LIMIT HAS BEEN EXPIRED VERIFIED THE
RECEIVED DATE -08/12/2022 VERIFIED THE TFL-90 DAYS FROM DOS ,CLAIM RECEIVED THE WITHIN TFL SO CALLED
INS @123-456-7898 S/W LISA SENT CLAIM BACK FOR REPROCESS VERIFIED THE TAT#30 TO 45 BUSSINESS DAYS
THEREFORE NEED TO ALLOW SOME MORE TIME TO PROCESS THE CLAM ,CLAIM# KLC7285483100
CALL#987654321

STATUS CODE:- TIMELY FILING LIMIT

ACTION CODE:-REPROCESS THE CLAIM

CLAIM DENIED FOR TIMELY FILING LIMIT FOUND THE POTFL IN WAYSTAR

ATTAACH :- [CMS-1500] DENIED [EOB] AND [POTFL] IN THE TEAM LEADER FILE EXPLORER.

3. DOS 07/28/2022 BA$1383.82 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @UHC CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 02/08/2023 AS THE TIMELY FILING LIMIT HAS BEEN EXPIRED VERIFIED THE
RECEIVED DATE -02/03/2023 VERIFIED THE TFL-90 DAYS FROM DOS CHECKED WAYSTAR FOUND POTFL ,VERIFIED
THE APPEAL MAILING ADDRESS PO BOX 5641 LEXINGTON KY,8564-6522 ,AFL-180 DAYS FROM DOD THEREFORE
NEED TO SEND THE POTFL UNDER THE CLAIM# KLC7285483100
 CLAIM DENIED FOR MEDICALLY NOT NECESSITY FOR COMMERCIAL INSURANCE .CO-50

1. DOS 06/21/2022 BA$1880.41 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @BCBS CHECKED EOB
ON WAYSTAR CLAIM WAS DENIED ON 04/20/2023 AS THE NOT MEDICALLY NECESSITY SO CALLED INS @123-
456-7894 S/W LSIA STATED NEED TO SEND THE MEDICAL RECORDS FOR WITH RECONSIDERATION LETTER ,ASK
TO VERIFIED THE APPEAL MAILING ADDRESS PO BOX 85112 ALPHANSO TX 95145-5656 AFL-180 DAYS FROM
DOD THEREFORE NEED TO SEND THE APPEAL WITH MEDICAL RECORDS UNDER THE CLAIM#3041750703
CALL#LISA-AUG-11-2023 TIME-01.33
 CLAIM DENIED FOR MEDICALLY NECESSITY FOR FEDERAL INSURANCE .CO-50

1ST STEP CLICK ON WWW.CMS.GOV/MCD,

2ND STEP SELECT THE LOCATION WHICH WE RECEIVED IN THE CLAIM FORM BOX NO.5
3RD STEP ENTER THE DENIED CPT CODE IN THE SEARCH COLUMN –CLICK ON SEARCH.
CLICK ON PARTICULAR ARTICLE#A58236

AFTER SEARCH IN THE ENTIRE PAGE WITH THE [CPT] CODE AND [DX] CODE WHICH WE HAVE RECEIVED IN
THE CLAIM FORM.

NOTES PATTERN#

DOS 06/21/2022 BA$1880.41 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @BCBS CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 04/20/2023 AS THE NOT MEDICALLY NOT NECESSITY UNDER THE LCD
GUIDELINES CHECKED CMS.GOV.IN FOUND THE VALID ARTICLE#A58236 NO DX AND PX CODE MATCHING VERIFING
THE CORRECTED MAILING ADD-PO BOX 1555 LEXINGTON NV 5556 CCFL-365 DAYS FROM PROCESS DATE
THEREFORE NEED TO SEND THE CLAIM TO CODING TEAM FOR THE FURTHER ASSISTANCE CLAIM#2223083172530
 CLAIM DENIED FOR NON COVERED SERVICES UNDER THE PROVIDER CONTRACT.CO-96

DOS 01/13/2023 BA$578.31 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @BANKERS ON LIFE
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 02/01/2023 AS THE NON COVERED SERVICE UNDER THE
PROVIDER CONTRACT SO CALLED INS @741-852-9632 S/W LISA STATED ITS TRULY NON COVERED UNDER THE
PROVIDER CONTRACT ,THEREFORE NEED TO SEND THE CLAIM TO CLIENT CLARIFIATION FOR THE FURTHER
ASSISTANCE UNDER THE CLAIM#2023000113893
 CLAIM DENIED FOR NON COVERED SERVICES UNDER THE PATIENT PLAN .PR-96

NON COVERED SERVICE PR-96 [OTHER INSURANCE] ACTIVE NOTES

DOS 01/17/2023 BA$575.86 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @FLORODA BLUE
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 02/06/2023 AS THE NON COVERED SERVICE UNDER THE
PATIENT PLAN SO CALLED INS @741-852-9632 S/W LISA STATED ITS TRULY NON COVERED UNDER THE
PATIENT PLAN ,CHECKED OTHER INSURANCE PATIENT HAVE @HUMANA VERIFIED THE ELG,EFF-01/01/2023
TO 12/31/2023 VERIFIED THE MAILING ADDRESS PO BOX 54623 ATLANTA GA ,9516 TFL-180 DAYS FROM DOS
THEREFORE CLAIM NEED TO BE FORWARDED TO @HUMANA UNDER THE CLAIM#Q10000103609392

NON COVERED SERVICE PR-96 OTHER INSURANCE NOT FOUND NOTES

DOS 01/17/2023 BA$575.86 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @FLORODA BLUE
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 02/06/2023 AS THE NON COVERED SERVICE UNDER THE
PATIENT PLAN SO CALLED INS @741-852-9632 S/W LISA STATED ITS TRULY NON COVERED UNDER THE
PATIENT PLAN, NO OTHER ACTIVE INSURANCE FOUND ON PATIENT ACCOUNT THEREFORE TRANSFER THE
BALANCE TO PATIENT UNDER THE CLAIM# Q10000103609392
 CLAIM DENIED FOR THE INCLUSIVE CO-97

HOW TO CHECK THE CPT CODE IN [NCCI] EDITS TOOL

1ST OPEN GOOGLE CHROME SEARCH WITH THE NCCI EDITS TOOL.
2ND CLICK ON NCCI PROCEDURE TO PROCEDURE LOOK UP.
 3RD SEARCH WITH THE DENIED CPT CODE OF BOTTOM OF THE PAGE IN
SEARCH OPTION

4THSTEP

ITS SHOWING ‘0’ ENTIRE CODES IS INCORRECT NEED TO SEND THE CLAIM TO CODING TEAM

ITS SHOWING ‘1’ MISSING MODIFIER

ITS SHOWING ‘9’ CODES ARE CORRECT NEED TO SEND BACK FOR REPROCESS

DOS 01/17/2023 BA$575.86 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @FLORODA BLUE CHECKED
EOB ON WAYSTAR CLAIM WAS DENIED ON 02/06/2023 AS THE INCLUSSIVE WITH THE OTHER CPT CODE ,SO
CALLED INSURANCE @123456779 S/W LISA STATED THE CPT 99215 INCLUSSIVE WITH THE OTHER CPT CODE 70154
HENCE NEED TO SEND THE CORRECTED CLAIM WITH VALID MODIFIER VERIFIED THE CORRECTED MAILING
ADDRESS PO BOX SALT LAKE CITY UT,CCFL-180 DAYS FROM PROCESS DATE THERFORE CLAIM NEED TO SEND THE
CODING TEAM FOR THE FURTHERE ASSESTANCE CLAIM#19202786240

 CLAIM DENIED FOR LACKS OF INFORMATION CO-16

 ALL CO-16 DENIED CLAIMS FIRST WE HAVE READ THE CAPTION OF REMARK CODE AND DESCRIPTION AND
AFTER WARDS WE CALL THE INSURANCE AND VERIFY THE ACTUAL STATUS OF DENIEL.

WITHOUT CALL THE CO-16 DENIEL WILL BE NEVER SOLVE CALL SHOULD BE MANDATORY.

NOTES
DOS 01/23/2023 BA$383.07 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @ALABAMA MEDICAID
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 04/21/2023 AS THE MISSING INVALID PROCEDURE CODE
AND DX CODE ,SO CALLED INS @123456789 S/W LISA STATED THE DX H52.7 IS INVALID WITH THE CPT CODE
OF 77370 VERIFIED THE CORRECTED MAILING ADDRES PO BOX 85642 SALT LAKE CITY UT 9519-5124 VERFIEID
THE CCFL-180 DAYS FROM PROCESS DATE THERFORE NEED TO SEND THE CORRECTED CLAM WITH VALID DX
CODE HENCE FORWARD THE CLAIM TO CODING TEAM UNDER THE CLAIM#203104035637 CALL#1-951236541

STATUS CODE -INVALID DX

ACTION CODE -CODING TEAM

 CLAIM DENIED FOR MAXIMUM BENEFITS REACHED

CO-119 PROVIDER PLAN
PR-119 PATIENT PLAN
BOTH DENIEL ARE SAME JUST WE CALL THE INSURANCE ASK HOW MUCH HAS BEEN MET AS A $DOLLER
VALUE OR VISIT WISE
IF IT’S A DOLLER VALUE ASK THE REPRESENTIVE HOW MUCH DOLLER HAS BEEN MET ,MENTION IN THE
COMMENTS HOW HE DOLLER MET AND SUBMIT
IF IT’S A VISITS WISE ASK THE REPRESENTIVE HOW MUCH VISITS HAS BEEN MET ,MENTION IN THE
COMMENTS HOW HE VISITS MET AND SUBMIT

ONCE ASK YOUR TL IF U BILL THE PATIENT ON THESE SCENERIO

DOLLER VALUE NOTES

DOS 04/12/2023 BA$53222.AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @ALABAMA MEDICAID
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 05/10/2023 AS THE BENEFITS MAXIMUM REACHED ,SO
CALLED INS @123456789 S/W LISA STATED CPT 99204 ITS DENIED DOLLER HAS BEEN MET ASK TO VERIFY THE
DOLLER VALUE $1500.00 HAS BEEN MET PER YEAR ,NO OTHER INSURANCE FOUND ON PATIENT
ACOUNT ,THERFORE TRANFER THE BALANCE TO PATIENT UNDER THE CLAIM#2223124004692

VISITS WISE NOTES

DOS 04/12/2023 BA$53222.AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @ALABAMA MEDICAID
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 05/10/2023 AS THE BENEFITS MAXIMUM REACHED ,SO
CALLED INS @123456789 S/W LISA STATED CPT 99204 ITS DENIED VISITS HAS BEEN MET ASK TO VERIFY THE
PATIENT VISITS HAS BEEN MET THREE VISITS PER YEAR ,PATIENT CROSSED THE VISITS TO MET THE LAST DOS
03/12/2023 NO OTHER INSURANCE FOUND ON PATIENT ACOUNT ,THERFORE TRANFER THE BALANCE TO
PATIENT UNDER THE CLAIM#2223124004692

IF OTHER INSURANCE IS ACTIVE VERIFIED THE ALL INSURANCE DETAILS,MAILING ADD ,TFL, AND BILL TO
THAT INSURANCE WHICH IS ACTIVE .
CLAIM DENIED FOR EXACT DUPLICATE NOTES PATTERN OA-18
 DOS-08/24/2022 BA $1232.75 AS PER REVIEW THE CLAIM WAS BILLED TO @ALABAMA,CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED 06/28/2023 AS CO18 EXACT DUPLICATE UNDER THE CLAIM#12345 ,SO
CALLED INS@1234567899 S/W LISA ASK THE ORIGNAL STATUS OF THE CLAIM,IT WAS PAID ON 10/01/2022
AS THE AMOUNT OF $600.00 AA $600.00 PR $00.00 IT’S A SINGLE EFT EFT#123456 ISSUED ON
10/02/2022 ,THEREFORE ADJUST THE BALANCE OF DUPLICATE,ORG CLAIM#987456 CALLREF#54612

STATUS CODE- EXACT DUPLICATE

ACTION CODE- WRITEOFF

*CLAIM DENIED EXACT DUPLICATE SENT BACK FOR REPROCESS NOTES

DOS-08/24/2022 BA $1232.75 AS PER REVIEW THE CLAIM WAS BILLED TO @ALABAMA,CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED 06/28/2023 AS CO18 EXACT DUPLICATE UNDER THE CLAIM#12345 ,SO CALLED
INS@1234567899 S/W LISA ASK THE ORIGNAL STATUS OF THE CLAIM NOT FOUND ANY ORIGNAL STATUS OF THE
CALIM SO PROBE REP SEND BACK FOR REPROCESS THE CLAIM VERIFIED THE TAT#30-45DAYS,THEREFORE NEED
TO ALLOW SOME MORE TIME TO PROCESS THE CLAIM UNDER THE CLAIM#1234567899

STATUS CODE-EXACT DUPLICATE

ACTION CODE-REPROCESS
IMPORTANT THINGS IN DUPLICATE DENIED

1.MOSTLY WHEN WE RECEIVED THE THESE TYPE OF DENIED FIRST WE CHECK THE DOS,CPT ,DX ,BILLED
AMOUNT,PROVIDER NAME AND TIMINGS .

2.TIMINGS WILL FOUND IN THE MEDICAL RECODRDS ,IF WE FOUND THE ORIGINAL CLAIM AND TIMING WILL BE
DIFFERENCE ON THAT TIME WE WILL ADD THE MODIFIER OF 76&77.

76- MODIFIER USE ONE WHO PATIENT TOOK THE TRATMENT FROM THE PROVIDER IN DOCTOR OFFICE AT 01:00
PM AND AGAIN THE PATIENT WILL NOT RECOVERED AT THAT TIME ,AGAIN THE PATIENT WENT TO THE SAME
PROVIDER AT 5:00 PM AND BILLING DEPARTMENT SUMBIT THE CLAIM 2ND VISIT TREATMENT ,ON SUCH TYPE OF
SCENERIO THE FIRST CLAIM WILL BE DENIED AS DUPLICATE .ON THAT SITUATION WE ADD THE MODIFIER OF [76]
ITS DESCRIBE THAT SAME DAY SAME SERVICE SAME PROVIDER .

77- MODIFIER USE ONE WHO PATIENT TOOK THE TRATMENT FROM THE PROVIDER IN DOCTOR OFFICE AT 01:00
PM AND AGAIN THE PATIENT WILL NOT SATISFIED FROM THE PROVIDER TREATMENT AT THAT TIME ,AGAIN
THE PATIENT WENT TO THE DIFFERENT PROVIDER AT 5:00 PM AND BILLING DEPARTMENT SUMBIT THE CLAIM
2ND PROVIDER TREATMENT ,ON SUCH TYPE OF SCENERIO THE FIRST CLAIM WILL BE DENIED AS DUPLICATE .ON
THAT SITUATION WE ADD THE MODIFIER OF [77] ITS DESCRIBE THAT SAME DAY SAME SERVICE DIFFERENT
PROVIDER .

 CLAIM DENIED SERVICE NOT COVERED BY PAYOR CONTRACT CO-109

 DOS-05/23/2023 BA $592.14 AS PER REVIEW THE CLAIM WAS BILLED TO MEDICARE,CHECKED EBO DENIED AS
CO-109 CLAIM/SERVICE NOT COVERED BY THIS PAYER/CONTRACTOR. YOU MUST SEND THE CLAIM/SERVICE
TO THE CORRECT PAYER/CONTRACTOR, CHECKED SECONDARY INS FOUND UHC WAS SECONDARY CHECKED
ELIGIBLITY IN AVALITY THE PATIENT WAS ACTIVE ON DOS FROM 01/01/2022 AND STILL ACTIVE, TFL 180DAYS
CHECKED MAILING ADDRESS 10066 AUGUSTA,GA 30999-0001, THREFORE TRANSFERED THE BALANCE TO SEC
INS UHC,NEED TO FOLLOWUP AFTER 30DAYS, CLAIM# :CD502TBEFCW

STATUS CODE- SERVICE NOT COVERED BY THIS PAYER/CONTRACTOR

ACTION CODE-BILLED SECONDARY INS

*SECONDARY INS NOT ACTIVE FORWARD THE CLAIM TO CLIENT NOTES

DOS-05/23/2023 BA $592.14 AS PER REVIEW THE CLAIM WAS BILLED TO MEDICARE,CHECKED EBO DENIED AS
CO-109 CLAIM/SERVICE NOT COVERED BY THIS PAYER/CONTRACTOR. YOU MUST SEND THE CLAIM/SERVICE
TO THE CORRECT PAYER/CONTRACTOR, CHECKED SECONDARY INS, NO INS WAS ACTIVE THEREFORE FORWAD
THE CLAIM TO CLIENT ASSISTANCE UNDER THE CLAIM# CD502TBEFCW

STATUS CODE- - SERVICE NOT COVERED BY THIS PAYER/CONTRACTOR

ACTION CODE-CLIENT ASSISTANCE

*IN SUCH SCENERIO THIS DENIEL CO-109 MOSTLY RECIVED FROM THE MEDICARE PAYOR PART A AND PART B
*IN SUCH TYPE OF SCENERIO BLIENDLY WE BILL TO ANY OTHER COMMERCIAL INS PART C

CLAIM DENIED FOR THE INFORMATION REQUESTED FROM THE RENDERING PROVIDER.CO-226
  NOTES PATTERN
DOS 05/18/2023 BA$139.07 AS PER ANALYSIS FOUND THE CLAIM WAS BILLED TO @UHC CHECKED EOB
ON WAYSTAR CLAIM WAS DENIED ON 07/27/2023 AS THE RENDERING PROVIDER INFORMATION HAS
BEEN INVALID CHECKED CLAIM FORM BOX NO-33 THE SAME INFORMATION HAS BEEN MENTION IN THE
CLAIM FORM SO CALLED INS @123456789 S/W LISA THE NPI IS MISS MATCH ON BOX NO-24.J VERIFIED
THE CORRECT NPI-123456789 NEED TO SEND THE CORRECTED CLAIM WITH VALID NPI-987456321
VERIFIED THE CORRECTE MAILING ADDRESS PO BOX 89546 SALT LAKE CITY UT,7895 CCFL-180 DAYS
FROM PROCESS DATE THERFORE NEED TO SEND THE CLAIM VALID NPI UNDER THE
CLAIM#KLC8792719500 CALL#123456789
STATUS CODE-CREDENTIOLING
ACTION CODE-CORRECTED CLAIM

IF NPI INFORMATION VALID ASK TO REP SENT BACK FOR REPROCESS THE CLAIM.
IMPORTANT DESCRIPTION
IN THESE SCENENRIO U HAVE TO CHECK THE CLAIM FORM BOX NO-33 THE SAME INFORMATION WILL
BE SUBMITTED ON INSURANCE COMPANY .
HOWEVER CHECK THE OFFICE CREDENTIAL SOP AND VERIFIED THE PROVIDER EFFECTIVE DATE AND
TERM DATE IN SOP SHEET BY CONFIRMING PROVIDER NAME AND NPI AND TAX ID

PROVIDER CREDENTIAL SOP WAS ALLOCATING OUR TL, IN SUCH TYPE OF DENIED FIRST ASK OUR TL
PROVIDE ME THE CREDENTIAL SOP.

 CLAIM DENIED FOR REFEREL IS ABSENT.CO-288

 *BEFORE GOING CALL FIRST CHECK THE INSURANCE CARD VERIFIED THE PCP NAME &PCP PHONE#
IF INSURANCE CARD WILL BE NOT AVAILABLE IN OUR SOFTWARE CHECK THE PATIENT ELGIBILITY IN
WAYSTAR AND SEARCH WITH THE PCP NAME AND PHON#

NOTES PATTERN – DOS 07/18/2023 BA$139.07 AS PER ANAYLSYS FOUND THE CLAIM WAS BILLED TO @VA CCN
CHECKED EOB ON WAYSTAR CLAIM WAS DENIED ON 07/27/2023 AS THE REFFEREL IS ABSENT CHECKED THE
PATIENT ELG IN WAYSTAR FOUND THE PCP NAME –BISH DONETTE VERIFIED TH PCP PHONE#334-566-8822
VERIFIED THE MAILING ADDRESS 1412 ELBA HWY TROY, AL 36079 VERIFIED THE FAX#334-670-8822 THERFORE
NEED TO SEND THE CLAIM CLIENT ASSISTANT CLAIM#J201X6YSZ0000

STATUS CODE-REFFEREL ABSENT

ACTION CODE-CLIENT ASSISTANT

IF REFFEREL AUTH# FOUND IN OUR SOFT VERIFIED THE EFFECTIVE AND TERM DATE FOR THE REFEREEL# AND
SEND A CORRECTED CLAIM BY TAKING CORRCETED MAILING ADDRESS AND CCFL.

 CLAIM DENIED FOR NO AUTHORIZATION ON FILE.CO-197

NOTES PATTERN

DOS 03/14/2023 BA$383.07 AS PER ANAYLSYS FOUND THE CLAIM WAS BILLED TO @UHC CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 06/05/2023 AS THE NO AUTHORIZATION ON FILE CHECKED IN OUR SOFT NO
AUTH VALID FOR THE DOS SO CALLED INS@123456789 S/W LISA ASK TO RETRO AUTH# LISA REFUSED THE RETRO
AUTH# REP SUGGEST NEED TO SEND THE RECONSIDERATION LETTER WITH MEDICAL RECORDS VERIFIED THE
APPEAL MAILING ADDRESS PO BOX 89546 SALT LAKE CITY UT,7895 AFL-180 DAYS FROM DOD THERFORE NEED TO
SEND THE CLAIM WITH MEDICAL RECORDS UNDER THE CLAIM#BHM9986093400 CALL#LISA -08/02/2023

STATUS CODE-AUTHORIZATION

ACTION CODE-APPEAL WITH MR

IF AUTH# FOUND IN OUR SOFT VERIFIED THE EFFECTIVE AND TERM DATE FOR THE AUTH# AND VALIDATE WITH
THE CPT,DOS,UNITS AND SEND A CORRECTED CLAIM BY TAKING CORRCETED MAILING ADDRESS AND CCFL.

 CLAIM DENIED FOR CORDINATION OF BENEFITS.CO-22 ,PI-22

 NOTES PATTERN BY CALL:-
DOS 07/13/2023 BA$139.07 AS PER ANAYLSYS FOUND THE CLAIM WAS BILLED TO @UHC CHECKED EOB ON
WAYSTAR CLAIM WAS DENIED ON 07/27/2023 AS THE CORDINATION OF BENEFITS CHECKED IN OUR SOFT
NO OTHER ACTIVE INSURANCE FOUND ,SO CALLED INS @123456789 S/W LISA ASK TO VERIFY THE PATIENT
LAST COB UPDATE DATE -01/01/2022 ASK TO LISA SENT A LETTER TO PATIENT UPDATE THE COB
INFORMATION THERFORE NEED TO ALLOW SOME MORE TIME UPDATE COB INFORMATION
CLAIM#BHM6154974500 CALL#54121564

STATUS CODE-COB INFROMARION

ACTION CODE-FOLLOW UP

IMPORTANT NOTE-IF IN OUR SOFT ANY OTHER INSURANCE IS FOUND WE DIRECTLY FORWARD TO ACTIVE
INSURANCE.

2ND NOTE- IF WE CROSSED THE SENT A LETTER TO THE PATIENT FOR THE COB UPDATE ON THIRD TIME
AFTERWARDS WE HAVE OPTION TO BILL THE PATIENT. BEFORE BILL TO PATIENT FIRST ASK TO REP HOW MANY
TIMES THE LETTER HAS BEEN SENT TO THE PATIENT FOR THE COB UPDATE IF REP SAID WE CROSSED FOR THE
THIRD TIME ,THEN WE HAVE OPTION BILL TO PATIENT.
 CLAIM DENIED FOR HOSPICE.PR-B9

IMPORTANT NOTE:-

BEFORE GOING ON CALL FIRST U HAVE TO CHECK THE CLAIM FORM AND EOB IS THERE ANY MODIFIER
APPENDED OR NOT ,IF MODIFIER IS NOT APPENDED THEN WE SEARCH THE CPT CODE IN GOOGLE AND
VERIFIED THE CPT CODE DESCRIPTION IS RELATED TO HOSPICE OR NOT.

IF CPT BILLED WITH HOSPICE RELATED THEN WE HAVE TO ADD THE MODIFIER OF [GV] AND SENT A
CORRECTED CLAIM WITH MODIFIER OF GV.

IF CPT BILLED WITH UNRELATED HOSPICE THEN WE HAVE TO ADD THE MODIFIER OF [GW] AND SENT A
CORRECTED CLAIM WITH MODIFIER OF GW.

NOTES PATTERN:-

DOS 09/21/2022 BA$2791.85 AS PER ANAYLSYS FOUND THE CLAIM WAS BILLED TO @PALMETTO GBA CHECKED
EOB ON WAYSTAR CLAIM WAS DENIED ON 01/12/2023 AS THE SERVICE NOT COVERED UNDER THE HOSPICE
HENCE CHECKED WITH THE CPT CODE ITS HOSPICE RELATED ,THEREFORE NEED TO SEND THE CORRECTED CLAIM
WITH THE MODFIER GV ,VERIFIED THE CORRCETD CLAIM MAILING ADDRESS PO BOX 65214 SALT LAKE CITY UT
8541 CCFL-180 DAYS FROM PROCESS DATE HENCE NEED TO SEND THE CLAIM WITH GV MODIFIER UNDER THE
CLAIM#2223005236410

STATUS CODE-HOSPICE

ACTION CODE-CORRECTED CLAIM

CLAIM PAID SCENERIO WITH ALL NOTES CO-45

CLAIM PAID NOTES :-

IF PATIENT RESPONSIBILTY COPAY,COINS,DEDUCTIBLE

DOS 01/05/2023 BA$3446.24 AS PER ANAYLSYS FOUND THE CLAIM WAS BILLED TO @PALMETTO GBA CHECKED
EOB ON WAYSTAR CLAIM WAS PAID ON DATE 02/13/2023 AS THE AMOUNT OF $717.58 AA$903.72 PR$180.76 ITS
BULK EFT $8189.92 EFT#806981610 CHECKED OTHER INSUARNCE PATIENT HAVE @UHC IS ACTIVE ON PATIENT
ACCOUNT VERIFIED THE MAILING ADDRESS PO BOX 18524 SALT LAKE CITY UT 85416-9857 TFL-180 DAYS FROM
DOS THERFORE FORWARD THE CLAIM SECONDERY INS @UHC UNDER THE CLAIM#2223010407410

STATUS CODE-CLAIM PAID

ACTION CODE-PAYMENT POSTING

NO OTHER ACTIVE DETAILS FOUND

DOS 01/05/2023 BA$3446.24 AS PER ANAYLSYS FOUND THE CLAIM WAS BILLED TO @PALMETTO GBA CHECKED
EOB ON WAYSTAR CLAIM WAS PAID ON DATE 02/13/2023 AS THE AMOUNT OF $717.58 AA$903.72 PR$180.76 ITS
BULK EFT $8189.92 EFT#806981610 CHECKED NO OTHER ACTIVE INS THERFORE TRANFER THE BALANCE TO
PATIENT CLAIM#2223010407410

STATUS CODE-CLAIM PAID

ACTION CODE-BILL TO PATIENT

*IF IN CALL SCENERIO CLAIM GOT PAID ASK TO THE REP FOR THE PAYMENT DETALS:

1.RECIEVED DATE

2.PAID DATE

3.HOW MUCH ITS WAS PAID

4.ASK TO ALLOWED AMOUNT

5.ASK TO IS THERE ANY PATIENT RESPONSIBILITY

6.CLAIM PAID BY THE EFT/CHECK

7.CLAIM PAID BY THE SINGLE OR BULK

8.IF CLAIM PAID BULK VERIFY THE HOW MUCH BULK AMOUNT

9.VERIFIED THE CHECK ISSUED DATE

10.IF CLAIM PAID BY THE CHECK VERIFY THE CHECK PAY TO ADRESS IN EOB AS COMPARE TO CLAIM FORM BOX
NO.[33]

11.ASK TO REPRESENTIVE FAX THE EOB ON FAX#

*IF IN CALL CLAIM GOT DENIED ASK TO REPRESENTIVE FOR THE DENIED RESON

1.RECIEVED DATE

2.DENIED DATE

3.ASK TO PARTIALLY PAID WHETHER FULLY DENIED REASON

4.WORKING ON ACCORDING DENIED SCENRIO

CLAIM GOT RECOUPMENT MEANS:-

CLAIM RECIEVED AND PAID AFTER INSURANCE COMPANY WILL BE TAKE BACK FOR EOB WHICH WE RECEIVED BY
THE PRVIOUS ONE.

OPTION TO PRESS THE IVR IN CALLING APPLICATION

1.PROVIDER

2.MEDICAL

3.CLAIM STAUS

AND AFTER WE HAVE TO ENTER THE TAX ID,NPI,MEM-ID,PATIENT DOB,DOS ,BILLED AMOUNT AND AFTER THE
IVR PULL UP THE PATIENT ACCOUNT DETAILS AND CONNECT TO THE REPRESENTITIVE.

HOW CONTACT HR TO JOB PURPOSE

GUD AFTERNOON MAM

ONE OF MY FRIEND SUGGESTED UR NUMBER FOR THE JOB REGARDING

HR WILL ASKING WHICH COMPANY UR PREVIOUS ORGANISATION

ASKING IN HAND SALARY

ASKING CTC

NOTICE PERIOD-DONE WITH MY NOTICE PERIOD