1.
Providers are paid per month for each member, not per service.
2.
claim is denied for “Not billed as Authorized” or “Service not Authorized
3.
claim(s) will go unpaid until the EOB is received to establish the primary insurance carrier.
4.
Claims are denied with this code when other insurance is showing as primary
5.
Unbundled procedure per NCCI rules
6.
Member not eligible on Date Of Service (DOS)
7.
When a claim is not received in the required time frames
8.
The process an insurance company uses to recover claim amounts paid to a policyholder from a negligent third party
9.
Once this is elected all claims pertaining to the members terminal illness will be filed directly to Medicare.
10.
When this happens you much advise the meber the claim is being reviewed and we can not provide any information.
11.
claim is the same service provided to a member on a specified date of service included in a previously submitted claim.
