What is Allowed amount/considered amount/Approved amount?
The dollar amount an insurance company deems fair for a specific service or procedure. This is the maximum amount that
Read More
ARCALLERDENIALS
What is an Advance Beneficiary Notice (ABN)?
A notice that the hospital or doctor gives the patient before the treatment, telling the patient that Medicare will not
Read MoreWhat is Ambulatory Surgery (ASC)?
Outpatient surgery or surgery that does not require an overnight hospital stay (more than 24 hours). Other names Day surgery
Read MoreMOCK-CALL_DEDUCTIBLE
Sandy: Thanks for calling this is Sandy how may I help you today? James: Hai my name is James I
Read MoreMaximum Benefit Exhausted/Met Denial.
Meaning: Some insurance companies limit the dollar amount they will pay per year for certain services or they limit the
Read MoreVoice-mail Procedure & notes format?
Why is a proper voice mail needed? A good voice mail will make the payer rep call us back with
Read MoreClaim Timely Filing Limits:
Sl.No Payer TFL Corrected Claim Filing Limit Appeal Filing Limit 1 AETNA 120 DAYS FROM DOS 180 DAYS FROM DOD
Read MoreEOB Calculation Formulae
Billed Amount = Allowed Amount + Contractual Adjustment Allowed Amount = Paid Amount + Patient Responsibility Patient Responsibility = Coinsurance
Read MoreMOCK CALL-DX code is inconsistent with the CPT code
James is AR CALLER Calling from India to USA insurance live rep in order to check the claim status the
Read MoreMock Call-Non-Covered service.
James is AR CALLER Calling from India to USA insurance live rep in order to check the claim status the
Read More