A guide to statusing and following-up on out-of-network medical insurance claims
Anesthesia- Pain Management
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Claim Denied
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YES
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Get specific info, why claim denied
is there specific info that can be submitted to have claim re-reviewed/reproc? If so,
-document in computer
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YES
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Get submittal info
-fax #
-ref#
-claim#
-specific documents to submit
-document in computer
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NO
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Do we have any pmt info in termlite
or do we have accurate pmt info in the computer?
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NO
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Find out where pmt is
Did pt rcve check?
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YES
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find out if check has been cashed, the exact dollar amt of check, what day the check was cashed and document all information in the computer
-call pt and send stmt with notes of pmt being due asap
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YES
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NO
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Does pmt info meet the criteria to be adj, or billed to pt?
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Was the check mailed to wrong provider address or another provider entirely?
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YES
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YES
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Follow appropriate next step of either sending pt a stmt or requesting acct be adj
-document in computer
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if so and there is no record of pmt in termlite,request a front and back copy of the check to be sent to office for pmt trace
(preferably have them fax instead of mail)
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Medical Claims Statusing
