NOTES (f/u):

DDE LOG ON AFTER LOCKED OUT: F3 AND TYPE ON INSCRIPTION LOGOFF ENTER AND WILL BE BACK TO
NORMAL, ALSO FSS0 ENTER TO BACK TO THE MAIN PAGE

CHECKING MEDIREGS: S1, -IF IS “J1” MEANS BUNDLED (PACKAGED), ASK IF THIS IS ON SPREAD SHEET
TO CG

WHEN RESUBMITTED CLM IS NEEDED: I NEED TO UNCHECK BOX TO AVOID HAVE THE OLD INFO FROM
THE PREVIOUS CLM BE TRANSFERRED TO THE NEW ONE AND END UP ON T AGAIN, (PER ML)

MEDIREGS EXP:

J1569-$43.14 X (4 UNITS) =$172.56 (MED NEC ADJ)

J1572-$35.07 X (4 UNITS) =$140.28 (MED NEC ADJ)

THE REST ADJ AS CO 3011, NOT ADJ THE WHOLE AMT, I HAVE TO UTILIZE MEDIREGS

WHEN MEDIREGS HAS “K” MEANS MULTIPLY BY UNITS -CHECK UNITS* ON REMIT DETAILS

S1=ADD, J1=SHOULD BE PAID BUT NOT.

PLACE CODE ON UB-04: ON CLM EDITS;

11-OFFICE 03-23 TO KNOW THE SOLUTION PULSE PG 4

21-INPT HOSPITAL AND SEE THE REMARKS D1-D9

22-OUTPT HOSPITAL

23-ER

Matt meeting 03.26.19*

WQ 682 OUTPT-WK PROJECT------INFO MCR 2 ND BUCKET, CH RA 23 CODE, 1679, 1680, 1681 GET BAL
PRIORITY

MOD Q1=ROUTINE SVC

ROUTINE SVC REQ Q1 MOD, NON ROUTINE SVC DOESN’T REQ NCD OR Q1-

*SNF MEETING*

PT MIGHT BE ON A SFN

-INCLUDED-MEANS SNF PAYS PER SNF BILLING GRID

-EXCLUDED-MEANS MCR PAYS

***IF IS NOT IN THE SPREAD SHEET, SHOULD BE BILLED TO SNF, PER CODE SVC***

LOOK FOR THE SNF ADDRESS AND CREATE A COV

-GO NOTES CLOSE TO THE DOS AND CHK >>>DISPOSITION<<< NOTE AT THE BOTTOM

FOR SNF AND HOSPICE;

ADDING COV AS MISC GOV COV, WE HAVE COV FOR A RENOWN HOSPICE AND SNF, KINDRED HAS THEIR
OWN.

ADJ NO MED NEC UNDER $500.00 IF PAST 120 DAYS FROM RA DATE CALCULATE ON THE VIRTUAL CALC

MCR WON’T PAY FOR HOSPICE, NO BENEFIT TO COVER THAT.

ENCOUNTER FOR PALLIATIVE CARE (MEANS HOSPICE)*

ON CLM UB-04 FOR HOSPICE AN NOT RELATED MUST HACE CC 07 ALWAYS.

RN WQ 583 CAN CHK IF IS APPROPIATE TO BILL HOSPICE, I CAN ASK..

ON CWF PG;

IF REVOQUE DATE SHOWS “0” IS NOT RECOV AND IF SHOWS “1” IS REJECTED, “0” OPEN

“1” CANCEL/CLOSE --- PG 18 ON HIQA FOR HOSPICE ON PROVIDER.I NEED THER FAC # AND FIND ON
SPREAD SHEET,IT WILL BE GET THE FAC #

BENEFIT MAX DENIAL;

ADJ AS 3011-3022 AS DENIED SVC

ASK A6 CHASE MEETING 04.02.19

*DELETE CHARGE ON EDITS VALS (a negative charge and if I have to do it, have to shows as positive on
Epic*)

DISPLAYS ON THE UB-04-AS NEGATIVE SVC/CHARGE, UNDO BILLING AND INITIATE BILLING

-GLOUCOUSE LAB $7.00 82962 (THIS SVC IS PACKAGE)

-when bypassing because no med nec, try to add the CPT code on the note, so the biller can know or I
can know at the time of the adj*

*BILLIBF IND (BI) 23 AND EXLAIN OR ADJ ON 3033 CODE IF THERE IS ANOTHER CLM LIKE FOR EXP INPT

*HOSPICE, USE ALWAYS CODE 50-(WHERE TO CHK?) FROM S1 TO 50

*POINT OF ORIGIN ON THE CODING SUMARY, TELLS WHERE THE PT WAS OR GO

*311 WQ TRAINING*

-ENCARCERATION CLMS;

CORRECT COV, LOOK FOR THE JAIL FACILITY, AS COV TO SEND THE CLM, SIMILAR AS COB ISSUE, IF
DENIAL. WE WILL BILL MCR AS 2ND
MISC COV FOR JAIL; AND IF COMES BACK TELL ML

WE NEED THE DENIAL WHEN THE INMATE IS BEEN FOR 30 DAYS QUALIFY FOR MEDICAID, LOOK FOR
POLICE REP, ON THE NOTES FOR THE JAIL FAC TO UPDATE ON COV.

-BILLING IND 23 IS FOR STOP CLM ON EDITS

***MSP***

CHK FOR 2ND PAYER, NORIDIAN MSP DECISION FREE, CHK CWF ALSO

*CONDITION CODES ON UB-04, CHK LIST.

*VALUE CODES, NOTE VC=12=0

IF THERE IS NOT ADJ MUST LIKELY NOT CONTRACTED (FOR A PRIME COV NOT MCR)

CHK ON RENOWN WEB *CONTRACTED LIST*

IF DOESN’T SHOWS AT THE WEB SITE, WE ARE NOT CONTRACTED (NO VALUE CODES WILL BE ADDED)

HX Trans TO CHK WHEN WAS PAID (WE NEED THE PAID DATE) CHK N THE EOB.

*OCCURRENCE CODES EXP;

24=PAID DATE OC 24=7.30.18

CHK F/U REP NOTES FOR MORE DETAILS.

*GO SSI-COB’S TAB, CHK LINKS AND ADJ

DED=1 VALUE CO-INS=2 CO-PMT=3

GO TO ERRORS AND CHK REASONS, DOUBLE CLICK TO GO PRIMARY CHK, PRIMARY ADJ BOX;

-FOR ADJ CODE OA, adj reason (care code) 204

-use appropriate CARC code (chase emailed) chk list adj amt $375.00 clm amt.

-co, contractual

-OA, OTHER ADJ

-PR, PT RESP

COB’S TAB, CLM PRIMARY # 1 (ADJUDICATION DATE), GO DOWN TO PAID DATE, BASED ON EOB.

GO TO NOTES ON REMARKS AND BYPASSED LESS THAN $500.00 MANAGE THIS ON SSI ON THE NOTE
ADD THE CPT CODE AND AMT.

-ON WC CLM EXP;

C4 FORM-CHK? ASK, ALWAYS CHK DOS AND NOT OVER 365 UNLESS WE HAVE A NEW EOB FROM PRIME.

WHEN NO PMT FROM PRIME IS BEEN MADE CHK 1 ST NOTES FROM RELATED REP (WC, TPL), WE NEED A
DENIAL IF THERE IS NO PMT LIKE A LT OR EOB.
IF I DON’T HAVE ANY INFO FROM TPL, WE NEED TP BILL MCR AS PRIME,

IMPACT TO PRIOR PAYER;

PMT+ADJ=80% INPT

-CHK RESPONSE HX TO CHK IF PT HAVE MEET DED IF SHOWS 0’S ALL OF WAY DOWN, EXP;

SSI GO TO CLM PAYERS, GO TO HX AND ADD VALUE CODES 12

PRIMARY PAID $0.00 VALUE CODES 44 PRIMARY PMT +PT RESP

OCC-CODE 24 DATE, ISSUE DATE 05.09.19

GO TO ADJ, ADD ONE (NEED TO MATCH TOTAL CHARGES)

PT-1-226-CO-45 GO NOTES, BECAUSE $0.00 PMT

ADD NOTE OR REMARKS; ALWAYS CHK IF PT RESP FROM MCR IS BEEN MEET…

OTUP, WILL REQUIRE A REMARK

CD=CHARGES WHEN TO DED, BOX # 1 AND VALIDATE, ALWAYS CHK ALL THE ERRORS-

COB’S, ADD PMT DATE ACCORDING EOB (IF IS CO-INS AND DED, I NEED TO SPLIT IT, ALWAYS BEFORE
BILL) TRY TO CALCULATE IF IS IMPACT TO PRIOR PAYER TO AVOID BILLING NO PMT, WILL GET.

FLRG, CODES NOT LOMGER USED

2019-BUT FROM 2018 SHOULD BE USEFUL THERAPIES

CHK MOD’S-50% LIMITATION INFORMATIONAL,

VALUE $0.01

G CODES TELLS MCR STATUS OF LIMITATION OF PT

EVAL=G CODES

DDE WEBINAR;
S/LS OF PROCESSING CYCLE (STS)

A=ACTIVE P=PAID

F=FORCE K=REJECTED

I=INACTIVE D=DENIED

S=SUSPENCE T=RETURNED TO PROV

M=MANUAL MOVE J=RETURN TO Q10

CHK ARROW KEYS

CTRL R (RESET) WHEN SCREEN FREEZES

F1=TAKE ME TO THE REASON CODE

F2= MOVE FROM 3 TO DETAILS INDIVIDUAL LINE

F3= EXIT, PRIOR PAGE, GO BACK, EXIT

F4= EXIT ENTIRE SESSION

F5= UP OR DOWN, SAME SCREEN, BACKWARD

F6= UP AND DOWN (SCROLL FWD)

F7= PAGE NEXT BACK (PREV PAGE)

F8= PAGE NEXT FORWARD (NEXT PAGE)

F9= SUSPENDS, TERM, CLM, REFRESH

F11=RIGHT

MENUS;
INQUIRIES-01, CLM SUMM 12

CWF=ELIGIBILITY, LOCAL FILE

WHEN WE HAVE A TRANS PT

PT NEEDS TO CONTACT MCR TO MAKE THE LEGAL CHANGES.

MARITAL OR DECEASE ISSUE TOO

IT SHOWS IF PT IS ELIGIBLE FOR SOME SVC, IF IS NOT ALSO, LIKE BECAUSE (AGE)

SCREEN 7 AND 8

FROM HOSPICE ADMITION, COVERAGE SHOWS JUST THE MUST RECENT,

SCREEN 9

SMOKING AND TABACCO, CHECK ELIGIBILITY FOR THIS PARTUCULAR BENEFIT

SCREEN 10

HOME HEALTH CERT

DRG-PRICER-GROUPER (CALCULATIONS)

REV CODES

REV CODE TABLE INQ

TOB-ALWAYS–DOS-HCPC CODE
REASON CODES-2 DIGITS ADJ CODE

XX7 AND XXQ IN DDE (ENTERD ON PG 3) SOULD BE REPORTED ON CANCEL TOB XX8

“CHK EOB MA44=APPEAL*

-201 PENDING CLMS

-361 DETAILED PROVIDER SUBMISSION REP

SORTED BY REASON CODE

-FOR ME; PH # 1 855 609 9960

WQ TRANCISION;

WHEN TRANSFER ACCT, I NEED TO COPY IT, CHK BOX ON THE BOTTOM

DON’T CLOSE DENIAL IF I NEED TO HAVE THE ACT ON MY WQ, OTHERWISE WILL GO FROM MY WQ AND
WILL NO T SEE IT AGAIN

TO ADD WQ;

COPY/TRANSFER TAB NOT WORK, UTILIZE 136 ACTIVITIY AND TO ADD TO WQ, AND USE “CLM ON PROC”
FOR DEFERING.

CO-97-DENIAL, OVERLAPPING CHK DDE, COULD BE OVLP ITSELF

RECCURRING MUST BE TARGET MUST THE TIMES OVER OUTPT

USING DCN# FROM CLM ALREADY PAID, TOB 137+CC D1-D9

TOB 137 MUST BE TPE TO TPE (BLANK)

USE F1 FOR SEE THE REASON AND DESCRIPTION

TPE TO TPE CHK, I NEED TO USE F8, F11 X 3, ALWAYS CH THE REJECTED ONE “R” NOT THE “T”

WHEN TPE TO TPE IS BLANK I NEED TO BILL 137 W/CC AND DCN#

TPE TO TPE (X) NEEDS TO BE BILLED 131 CLM AND RESUBMIT, CHK REASON CODE BY USING F1 AND
CORRECT ERROR, NO DCN# , ADD NOTE

WEBINAR DDE 4.16.19

MID=MCR=ID #

NDC-NATIONAL DRUGS CODE

F1=REASON CODE F4=EXIT F7=LEFT F10=LEFT

F2=TO JUMP F5=BACK F8=FORWARD F11=RIGHT

F3=PREV SCREEN F6=DOWN F9=UPDATE, REFRESH, CANCEL

CLM ENTRY-TO SUBMIT A BRAND NEW CLM 3 RD DIGIT=ON TOB-FRECUENCY CODE NAME

INAVALID TOB XX5, XX8

MENU-CLM ENTRY MENU

CHOSE THE SPECIALTY (OUTPT)

PROVIDER TOB

CLM ENTRY-SCREEN- USE F8 FOR NEXT PG, CHK TOB AFTER MID# USING TAB KEY, TO MOVE BETWEEN
FIELD ON SHORT CUT (SC) I CAN ENTER AN INQUIRY FOR A QUICK FIND OR GO F3 TO EXIT TO 1 ST PAGE

SCREEN 2, (F8)

SHOW THE ITEMS BILLED AND WE CAN MANIPULATE

D+HOME+ENTER TO REMOVE A LINE COMPLETELY ON THE REV COLUMN.

IF NEED ADD A NEW THING GO TO BOTTOM AND HIT ENTER.

SCREEN 3

INFO FROM DR’S AND INS INFO RELATED

F11 TAKE ME TO THE CARC CODE, PT INFO FORM PRIMARY PAYER

IS THIS INFO IS NOT THERE, MCR IS NOT IDENTIFYING AS PRIMARY, PAID DATE, SHOULD BE MATCHING
W/EOB, IF THERE IS MULTIPLE PAYERS LIST

SCREEN 4

REMARS, ADD AS MUCH INFO WOULD APPROPIATE AND INITIALED

SCREEN 5

OTHER INS INFO AS MSP*

SCREEN 6

ADDITIONAL PT INOF AND PMT INFO TO ITS ROSTER BILLING FOR VACCINES

CLM SUMMARY (ON 01-12) INQUIRIES /SUMMARY

PB9996, ALMOST PAID PB9997, PAID RB9997, REJECTED TB9997, REJECTED-STS CODES

SCREEN 7

ADD INFO REQ BY MCR

CLM CORRECTIONS (ON 03-23)

CORRECTIONS WHEN T STS, TO SUPP CLM ON SV FILED AND ADD Y+HOME+ENTER+F9

CLMS ENDING ON 8 TOB, CANNOT BE SUPP, FINALIZED CLMS CANNOT BE ADJ...

ADJ FOR MED NEC=CORRECT UNITS ECT

TIMELY ADJ= REPLACES W/TOB 137

REOPENINGS=REPLACES CLM W/TOB XX8, XXQ

CHK 1423 DETAILED INFO THERE IS A LIST OF REASONS

REJECTED VS DENIED

ADJ TAB;

SELECT THE LINE I WANT TO CANCELL OR CHANGE AND MUST BE ADD CONDITION CODE TO JUSTIFY
WHY THE CHANGE FROM D0-D9

-D0 HAS THE HIGHEST PRIORITY

-D9 ALL OTHER OPTIONS AND NEED A REMARK

AFTER THE CHANGE, I NEED TO PERFORM AN ADJ AND GO TO ADD THE REMARKS, SPECIALLY WHEN
USED CC D9

*CC-TOB REAOSN CODE AND REMARK AND CANCELATION CLM.

PB9997, RB9997, DB9997 MEANS FINALIZED

CLMS FOR APPEAL NECESSARY

TOB 138 MAY RESULT IN RECOUPMENT IF THE REIMB WAS MADE ON THE ORIGINAL CLM

-INVALID OPTION FOR CLMS I=IN PROC LOCATION SB6000, SMMADJ

CANCELATION CLM, CHOSE MY SPECIALTY AND CHOSE OUTPT SI

CANCELATION CONDITION CODES

D6-ALL THE REASONS, NEED A REMARKS.

NEW ON APRIL

10097-OUTPT PROVIDERS

ACTIVATION OF SYSTEMATIC VALIDATION EDITS FOR OOPS, LOCATIONS MUST BE MATCHING, PROVIDER
PRACTICE OPTION 1D ON MENU ON THE RIGHT COLUMN IN THE BOTTOM CARC, RACR

WHEN EDIT MUE ON UB-04;

CALCULATE, FIX AND ADJ, 5052 AS NON BILLABLE ON MUE TABLE, ADD COMMENTS, REMOVE BILLING
IND 23 BI23 GO TO ACCT ACTIVITIES , GO 2ND COLUMN AND 23 AND WHY WE REMOVED, CHANGE LAST
TAB 5 ACCEPT

MUE TABLE ON DRIVE O

Z CODES-ARE FOR GENETICS AND MCR DON’T COVER THOSE 3016 ADJ AND 3011
FOR SUPP CLM; GO TO 1ST PG, SELECT 03-23 =, GO TO SV TO SUPP AND ADD Y+HOME+ENTER+F9

DELETE CHARGES; BY LINE* GO TO EDIT VALS, CLICK ON EDIT LINES ON TOP AND DELETE AS NEEDED,
ASLO PERFORME AN ADJ TO HAVE THE CLM AS I NEED TO BE BILLED

FOR BILLERS; NOTES*

FOR CHEMO, USE THE MAAB-DRUGS-CHEMO DRUGS,

CHARGES HAVE NOT PROCESS ON THE DDE, CLM DELETED ON SSI, BEFORE RESUBMITTED, CHARGES
NAVER MADE IT TO DDE (CG SUGGESTED NOTES)

990, PT CONVINIENCE ADJ 5052 NO RE BILLED

MEETING 04.22.19
IF I RESUBMITTED CLM BY BAB, USE THE RESUBMITTED CANNED NOTE

TO ADD TO A PRIMARY OR SEC WQ, I NEED TO USE THE FORMAL NOTE THAT I USED FOR ANTHEM.

DO NOT USE REBILL/RESUBMIT NOTA THAT IS JUST FOR MK AND JA

ON F/U NOTE I NEED TO DETAILED, NOT TO ADD CCD1, DCN# OR TOB THAT IS JUST FOR MK AND JA

I NEED TO SAY JUST WHAT I WANTED OR NEED, DO NOT DO ANY ACTION, I AM NOT A BILLEDR JUST F/U

DO NOT USE BILLING INDICATOR 23

TRANSFER COMENETS BECAUSE KH 254 WQ USED TO BE

TPL- CHK NORIDIAN DX CODES IF THEY MATCH WITH WHAT WE HAVE ON FILE, TPL IS PRIME IF DON’T
MCR IS OK TO BE PRIME.

MEETING 04.23.19
-REBILL PRIME, GOES TO WQ 5951, RESUBMIT THROUGH BAB BUTTON ADD TO THE WQ USING
FUNCTION 136, USE PRIMARY NOTE, AND USE THE F/U

-CLM STS LOCATION CODE, EXP: TB9996, ACTION TAKEN CLM DELETED (EXP 15867450, NOTES DONE @)

-COMBINE AND SEPARATE*

OSC, OCCURRENCE SPAN CODE (MAKING A GAP ON BETWEEN ACCT’S), 74 TO AVOID OVLP AND TO
ADVICE MCR TO PAY ON CERTAIN DATES AND WHAT WE DON’T.

-CHK FOR OC, CC AND OSC CODES

-WHEN COMBINE, COPY AND PASTE THE OVLP INTO THE NOTE, AND SPECIFY WHY, ON THE TARGET
ACCT.

-BILLING-IS THE INFO, I WANT TO BE BILLED? AND THE F/U NOTE IS TO ADD HOW THE ACCT WAS
BEFORE I REQUEST TO BE BILLED.

-EXP, TO TOB 137 TO 132*

-DEFERRED FOR MK AND FOR MCR 19 DAYS

109 20-23=19 AY NEEDS TO GO TO JR*

*T STS DO NOT NEED DCN# CC OR TOB, (DOESN’T NEED TO CHANGE TOB, MUSR BE THE ORIGINAL)

-CLM SUMMARY INQUIRY

1ST GO TO # 03, THEN 2ND GO TO THE #23, ENTER THE INFO, GO F8 TO CHK WHAT SVC WERE DENIED*

-MAKE AND ADJ THRU CALC EXCEL-

3016-ALLOWABLE AND 3011 CO (NO DCN#, NO CC, ORIGINAL TOB)

F8-NEXT FOR ANOTHER CODE

I NEED TO ADD CLM TO 5951* M RESPONSIBILITY IS TO SUPPRESS CLM ON DDE AND JUST MAKE THE
NOTE OF WHAR I WANT IT TO BE BILLED

Z MOLD-GENE

-WHEN ORIGINAL REBILLING MUST BE 131 NO D1, NO DCN*

SURGERY/OBSV-NO MORE THAN 48 HRS, WHEN CHARGE

-WHEN ALL INFO IS CORRECT JUST F9’ED ON CLM SUM INQU NO TO “Y’ED” REQUIRED, F9 IS LIKE
REFRESH*

CONDITION CODE CC45, AMBIGUOS GENDER, WHEN APPROPIATE.

MEETING 04.24.19 (ML, KH)

NO PMTS FOVUS, SPREAD SHEET

CHK COLUMN Q MAKE AN ADJ IF NEEDED

COLUMN AC, CHK FOR DATE OF PMT

SKIP ACCT’S FROM DENISSE RN, ADD EXPECTED APPEAL DATE*

*WORK T STS W/RB AND CG

-2 COLORS USE, GREEN/YELLOW, GREEN DONE, YELLOW PEND

FOCUS ON HIGH DOLLAR ON SPREAD SHEET*

ATTENTION TO DISCGARGE DATES AND CHK TIMELY FILING ACCT’S, IF ID A LAB, ADJ AS 3026 IF IS OLD

-AA/AB COLUMS ARE MSP’S

MCR TIMELT FILING 365 FROM DISCGHARGE DATE.

-COLUMN 2 LAST TIME WORKED ACCT*

GO LIAB BKT, OPEN AT THE DENIAL UNDER CLM RECONSILATION HIDE DETAIL FOR INVOICE, OPEN ALL
THE TABS
AFTER SUBMITTED A CLM, WILL BE ON DDE ON 3-5 DAYS TO F/U*

HIC-MID-ID #=MEMBER ID #, ERROR U5061 MEANS MEMBER ID# INCORRECT OR PROBLEM ON IT

DDE WEB-SV SPACE=ENTER THE ERROR CODE TO SEE THHE DEFINITION

DENIAL; WHEN DENIAL AS A1 OR VAUE CODES, WE NEED TO GO TO CLM SUMMARY INQUIRY ON 03-23
AND DELETE VALUE CODES VC+F9 AND ADD NOTE FROM T STS

TO COMBINE ACCT’S

RECCURRING-TARGET NOT ALL OF THEM

OUTPT-SOURCE, ASK 1ST OR USE THE GRID

-WHEN CALLING MCR, REP JUST HELP W/3 CLMS, IF MY ACCOUNT HAS 1 OR 2 BKT’S IT COUTS LIKE 1 OR
2 CLMS

HOSPICE DENIAL; WHEN NOT RELATED TO HOSPICE DX CODE, I NEED TO ADD CC 07, TX-NON TERMINAL
CONDITION FOR HOSPICE PT

Meeting 05.01.19
To filter wq as alphas for me

DO NOT NRP, IF THEY REQ A 138 TON, MY OUTPT AND NEED TO DEFER NORMALLY COUPLE MONTHS

OC CODE 11 FOR WHEN PT START BEEN SEEN

OC CODE 05 LIKE ACCIDENT OR EXTERNAL CAUSE OF INJURY

NO OC 11 ON INPT CLMS

T STS ON DDE TO SEE STATUS, OPTION 17 AND F1

MEETING 04.07.19
IF INCARCERATION IS NOT SHOWING AT NORIDIAN, WE CAN RE BILL AFTER DENIAL

CHK CODING STS AT THE POINT OF ORIGIN, NON HELATH CARE OR CHK IF DIFFERENT INFO IS THERE

-WHEN S CODE IS PRESENT MCR WON’T PAY

-WHEN ELIGILBITY IS BEEN UPADATED, I NEED TO BILL W/ TOB 137

-SKIN SUBTITE, CHK CHARGES ANDSEND IT TO VS

-SKIN PRODUCT FOR IMPLANTS GOES TO VS, Q CODES LOOK ON (636)

-IF CLM IS ON T, WE HAVE TO SUPP (AS F/U) DUTY

-J1=MENS PACKAGE ON MEDIREGS OR IN AMBULATORY, IF THERE IS 2 J1, THE LOWER GOES PACKAGED
ON THE HIGHER ONE

HOSPICE DENIAL WE NEED TO KNOW DX CODES

SNF, I DON’T NEED TO KNOW THE DX OR ANYTHING WHEN IT FALL ON THE TIME OF DOS, CHK
NORIDIAN FOR OVLP DATES

GO TO EPIC AND CHK REPORT, NEW CLINICAL CODING, BY CALLING THE FACILITY OR CHK CHART NOTES,
PER DOS AND OPEN THE NOTES FROM DOS

CK ALWAYS THE EXCLUSION ON SPREAD SHEET BY CG, IF IS NT ON THE LIST, IT IS SUPPOSED INLCUDED

>ALL THE IMAGINING SVC, CMR PAYS WHEN SNF, IS INVOLVED

PARTIAL SNF DENIAL

UNEDR $500.00 GOES TO 3022 AND 3011 CO AS MED NEC EXP OVER $500.00 AS CG*

WHEN COMBINED ACCT’S AND THE CORRECT CLM HITS T STS , I WILL NEED TO RESUBMIT CLM W/D1,
DCN# AND TOB 137, ALWAYS ADD THE CLM # FROM THE CLM THAT PAID.

MEETING A/R LEARNING 04.14.19

1. HX BILLING REP 4. REPORT FOR DISCHARGE DATE # 1

2. AGING 5. AGING DAY BEFORE EXP 04.13.19 (ALWAYS DAY BEFORE)

3. SVC AREA # 10 6. GROUPING, LOCATION FINANTIAL CLASS, ACCT CLASS

CLM FROM TYPE,

7. RUN (GROUPED BKT LIST)

-FOCUS MCR- (PINCH THE LNNK AND OPEN , I CAN EXPORT IT TO A SPREAD SHEET AND CHOSE MY
ALPHAS, SAVE IT ON THE DRIVE, NAME IT ON (BUSS SHARE) Add act id # to the list

 CHOSE ON 1ST PAGE MCR AT THE LEFT AND CLICK OPEN BY DETAILED LISTING OF LIAB BKT’S

-CHOSE ACCT CLASS ON TOP*

TO EXPORT;

-ACR ID #, INV #, ACT NAME, FINANTIAL CLASS, ADMIN DATE, DISCH DATE, DEPT NAME, TOTAL CHARGE,
TOTAL PMT, SAVE 1ST OPTION.

T STATUS;

WHEN COMBINE ACCT, I NEED TO ADD B1 23 (BILLING INDICATOR) TO HAVE DETAINED ON EDITS 137-
DCN#-CC D1

T STATUS, ISN’T PERMTTED TO ADJ A PARTIALLY OR FULLY MEDICALLY DENIED CLM, MEANS,
SOMETHING IS BEEN DENIED AS NON MED NEC AND NEEDS TO BE RE BILLED, ALSO TO CHANGE THAT
NON COV CHARGE TO NON COVERED CHARGE COLUMN.

T STATUS; NOTE MUST INCLUDE THE REASON CODE IT’S a # ON THE DENIAL

WHEN T’S TPE TO TPE IS NOT IMPORTANT, JUST FOR TE REJECTED ONES OR P STS TPE TO TPE
T STATUS; ENTER Y AND HOME-ENTER+F9

WHEN CLEO CANCEL OUTPT, I NEED 3033 UNDER $5000.00 OVER, I NEED TO ASK

WHEN ABN PRESENT, I NEED TO ON OC OCCURRENCE CODE 32 ADDING AND ABN SIGN DATE

ADD MOD GA AT THE CPT CODE FIELD AND ALSO THE NON COVERED AMT (MOVE IT) TOB 137 AND D9
UST BE ADDED AND EXPLAIN @ THE END DCN# AND ADD THE REMARKS AS ADDED GA MOD TO CPT #
AS NON COVERED AND NO MED NEC.

MEETING 05.16.19 F/U

-$160.00 LAB SVC, DIVIDE 72 3011-3033

LESS $500.00 IF THE CORRECTED CLMWAS BILLED JUST WAIT

-WHEN DX CODE CHANGE, WAIT UNTIL PROCESS, F/U, IF T’S FINF OUT, MAKE SURE TOB 137 AND NON
COV ITEMS ARE ON PLACE, REMARKS AS WELL, D9, DCN#

-N=MEANS, (MEDIREGS) PACKAGE, STATUS INDICATOR UNDER N BEEN ADJ AS PACKAGED=3011 MEANS
CO

-SPAN CODE 74, SPECIFIC DATES NON BILLED MUST BE BILLED AS PT WAS NOT HERE

-SPAN CODE 72 IS JUST ONLY FOR INPT USE*

DNB-DISCHARGE NON BILLED*

CLM EDITS, ALMOST READY TO BILL

-COB, AFTER 3 ATTEMPS, EVERY 10 DAYS, I F PT DID NOT UPDATE IT, NRP VALID*

MATT MEETING 05.20.19

FOR DENIALS, WE NEED TO CHK THE AMBULATORY AND IF HAS N, MEANS PACKAGED

-TO BILL Z CODES; AFTER CLM;

GO TO CLM EDITS, I NEED THE INFO FROM THE Z CODES, CPT CODES AND AMT, GO TO LIAB BKT, EDITS
VALS ON TOP, GO TO EDIT LINES, AND WHEN OPEN, DELETE ON THE BOTTOM, AND THEN ACCEPT, TOB
131 AND OK’ED AND INV # AND NEW AMT $, CHK FOR BILLING INDICATOR AT THE SUMMARY , ADD THE
NOTE, IF I AM ON THE WQ, I NEED TO REMOVE FROM WQ BY COMPLETED AT THE ACCT ACTION SPECIFY
THE CPT CODE THAT WAS REMOVED AND RESUBMIT ON BAB BUTTON.

WHEN WE HAVE A PMT ON BKT, AND I NEED A CORRECTED CLM, FCHK FOR NON COV CHARGES AND
GOTO RA AND CHK FOR 50 CODE DENIAL TO HAVE IT MOVE BACK TO NON COV COLUMN

WHEN I NEED TO BILL 131 W/141-147 GOES ON 131 AND I NEED TO CANCELL 141 WITH A 148 ON DDE
AS F9

WHEN REJECTED CLM 131, I NEED TO BILL 137 AND CHK TPE TO TPE DCN# AND CC D1 TOB 137 AND
REMARKS, NOTE EXP FOR COB CWF IS BEEN UPADTED MCR IS PRIME.
WHEN ADDING GA, I NEED OC 32 W/ DATE

NO ABN ON FILE,LIKE FOR EXP FOR PSA, I NEED THE GZ MOD, AND MOVE THE CHARGES TO NON COV
COLUMNON THE BOTTOM OF THE UB-04, IF IS ANY 20 CC, DELETE

S CODES (SMOKING) ARE THE SAME PROCESS AS THE Z CODES, SMOKE CESSASION, ADJ AS 5052 AND
CHK FOR CC D7 THEY HAVE

WHEN VASCULAR DENIES, MIGHT BE AS MED NEC, USE ADJ AS 3050 FRO NO ABN ON FILE, IF THERE IS
NONE 3022 AS NO COVERED FOR THE POLICY

LCD, WHEN IT SAYS NON COVERED, 3022, WHEN SHOWS MED NEC 3018

MATT MEETING 05.29.19

FIX 3RD BKT AFTER A PMT OR RE-PMT WAS MADE TO MCR

-DOWN THE PMT, FIX THE 2ND BKT BY MOVING THE ADJ AND PMT DOWN.

DIANA TORRES @ CREDITS WANT THAT

VASCULAR STRESS TEST, ADJ ACCORDING TO EOB, 3022 NON COV OR 3018 AS NO MED NEC

05.30.19
MSP WORK, TOTAL CHARGES @ 80%, PRIMARY PMT AND ADJ (ADD) AND SHOULD BE 80% FROM TOTAL
CHARGES, IF IS MORE, WILL BE ADJ AS IMPACT TO PRIOR PAYER.

-CHK PREVVIOUS CREDIT ON MCR AND IF MORE OF 80% IS, I NEED TO ADJ AS 3011 IF PT ALREADY MEET
THE DED OF THE YEAR, CHK NORIDIAN FOR THAT INFO

-CHK NORIDIAN, MUST BE $0.00, IF DON’T LEAVE FOR CG AND RB TO HAVE IT BILLED, EVEN IF MET THAT
80%, HAS TO HAVE THE 2 THINGS, OTHERWISE ,NEEDS TO BE BILLED.

DOS OVLP INCORRECT; WHEN IT SHOWS A DUP BECAUSE DOS I NEED TO DO;

UNDO BILLING TO THE ONE IS BEEN PAID, WAIT FOR A PMT TO POST AND UNDO BILLING, AND INITIATE
BILLING WITH CORRECT DOS ON THE WINDOW , RE BILL AS 137, CC D9W/ REMARKS FROM DATE
CORRECTED, DCN# FROMCLM PAID ONCE IS SHOWING AS PAID THEN CAN F9’ED THE ONE ON T STS
(JUST REFRESH)(NO HOME+ENTER)

MATT MEETING 06.04.19

USE FIRST COAST RESOURCES, SERVICE OPTIONSWEB SITE

FOR CHK DDE REASON CODES

-PAIN MANAGEMENT DENIALS, FOR MED NEC, SHOUJLD BE CHK BY VS OR RN DOESN’T MATTER THE
AMT ANYMORE*
MATT MEETING 06.18.19
-WHEN COMBINING ER W/ RECCURRING, ER MUST BE MY TARGET.

-WHEN REBILLING Z CODES MUST BE 131 NO CC D1, NOT DCN#

-DENIAL 88187

-CYTOMATRY-CPT CODE 88187 MUST DENIED ALWAYS, CHK IF THIS IS DENIED ON MEDIREGS PER OPPS

-VAUE CODES DENIAL-

WHEN DENIED AS VALUE CODES, I NEED TO ENTER ON CLM CORRECTIONS AND DELETE THE VALUE
CODES FROM THERE ABND THEN SUPP AND RE BILLED AS NEW.

CG MEETING 06.20.19
WHEN COMBINE ACCT

-ONE WAS PAID, I NEED TO ADD BI 23 TO HAVE IT STOP IT AND ADED TO MK WQ

TO ADD CC D1, DCN AND TOB 137*

I HAVE TO ADD AID CLM 3 IF DENIED OR REJECTED, I NEED TO IGNORE THE TPE TO TPE X AND USE THE
CORRECTED CLM INFO ON NEW CLM AND RESUBMIT, CLM, WILL BE DENIED AGAIN AS INCLUSIVE BUT
INDEED, WHAT IT NEEDS IS TO HAVE A CORECTED INFO

5052 OVLP ACCT’S DENIED OVER THAN 365 DAYS

MEETING 06.21.19
-74, LEAVE OF ABSENCE OUTPT

-72, JUST INPT USE

TRANSFER CHARGES TO ANOTHER ACCT BECAUSE DX CODES CHK THAT

SELECT ALL, GO TO ACTIONS, 2ND LVL

TRANS, ADD THE HAR # ANDCANCEL THE CLM THAT TRANSFERRED INFO ON THE DDE 03-51 TO CANCEL,
ADD CC D9 ON THE REASON CODE DX AND REMARKS , CANCELLING CLM AS OVLP

INITIALS AND DATE AND F9

NOW, UNDO BILLING ON NEW ACCT THAT I TRANSFERRED, WORK LATE CHARGES ANDREVERSE adj, on
old acct, use late charges REPLANCEMENT CLM ADD CC D1 SOMEWHERE ON THE FRAME FOR LATE
CHARGES

WHEN CORRECTED, WE NEED REMARKS THAT RE BILL W/ REMARKS LETTING MCR KNOW THAT THE
CODES ARE DENIED AT THE BEGINNIG F8 PG 2 NEED TO BE REMAIN THAT PMT IS NOT NEEDED WHEN
ADDING CC D9 ALSO
MATT MEETING 6.24.19
WHEN CLM ON T AND WE HAVE NO REASON OR BILLED INCORRECTLY, WE MUST ADJ AS 5052.

AY DENIAL, ON TT, SEND IT TO 5951 AND NOTE IT , SUPP CLM, RESUBMIT AS TOB 137 , MOVE THE NON
COV OR GA SVC IF THERE IS SOME OTHER TO THE NON COV COLUMN .

WHEN DX CODE CHANGE CLM IS ON T STS, WE NEED CC D9 AND REMARKS, CHK FOR IT

WHEN CHECKING FOR T STS I NEED TO CHK THE SAME (ALL THE TIME BECAUSE THAT MIGHT BE THE
REASON FOR DENIAL)

ON T STS CLMS W/NO CHARGES, WE DO NOT NEED TO ADD CC D1 OR THE OTHER STUFF

WEBINAR 06.27.19
THERAPY BILLING
*CR 11120 EFECT, 01.01.19 IMPLEMENTED 02.29.19

*HCPCS G CODES AND MODS

NO LONGER G CODES, NOT REQUORED JUST INTERNALLY.

*LOL=LIMITATION OF LIABILITY

WHEN SVC IS NOT MED NEC, WILL GO TO PT, USE KX MOD WHEN OVER THE LIMIT SPECIFIC AND
INFORM PT AND SIGN AN ABN, NO USING THIS MOD PROVIDER WILL BE LIABLE USING ABN FOR 03.2020

MISSING ITEMS WILL MAKE ABN NOT VALID ON THIS SCENARIOS ABN IS MANDATORY

WHEN IS NOT MED NEC OR WHEN IS REACHED THE BENEFIT MAX, IF IS NOT IN COMPLIANCE PROVIDER
WILL BE LIABLE.

WHEN PT HAS REACHED AL BENEFITS UNTIL REACHED WE NEED THE MOD KX, IF IS MED NEC WE NEED
TO:

WE NEED THE ABN IF THE MED NEC IS NOT REASONABLE OR REACHED BENEFITS

PT NEEDS TO SIGN IT UP BEFORE CARE SVC AND GIVE THEM A CORRECT ESTIMATE WHEN PT AGREES TO
PAY WILL BE ADDING GA MOD

IF PT NOT AGREED TO PAY, WE DO NOT NEED TO SUBMIT A CLM.

GA=ABN GIVEN AND PT KNOWS MIGHT BE LIABLE

GX=WHEN ABN FILLS OUT VOLUNTARY FOR CORRECT SVC

GZ=NO ABN GIVEN, PROVIDER LIABLE

PT, OT, SLP (MUST BE ONE-ONE CLM OR CAN BE IF THEY ARE ON THE SAME MONTH

GN=UNDER SPREECH, LAUNGUAGE PATHOLOGY PLANE OF CARE

G0=UNDER OT PLAN CARE

GP=UNDER OUTPT

NO FOR RESPIRATORY OR NUTRITION JUST FOR PHYSICAL AND SPEECH THERAPY

KX= FOR MED NEC W/THE THERAPY MODS

OCCURRENCE CODE NEED 11 ONSET OF INJURY 35 PT START CARE, 29 PT PLNA CARE ESTABLISH, DATES
MUST BE THERE FOR OT, PT SPEECH

OCC 44= USED WHEN INPT ADMIN NEEDS TO BE CHANGED TO OUTPT STATUS

OCC 45= SLP START

OCC 30= SLP CARE ESTABLISH

APPROPIATE CPT CODES AND MODS UNITS SPECIFICALLY IN MINUTES*=1 UNIT PER VIIST

UNTIMED CODES-EVALUATIONS

TIME BASED, 8 MIN RULE

AVERAGE 15 MIN PER UNITS

UNITS CONSTRAINED BY TOTAL RULE

FOR PHYSICAL T CPT CODES ARE BASED ON TIME

PTP=PROCEDURE TO PROCEDURE

PMT=MODS 25 AND 59

-ASK ML FOR THE CYTOMETRY SVC THAT THEY ARE ALWAYS DENIED-

-POW WOW, CG 07.09.19

-BEFORE ESCALATE ANYTHING, WE NEED 3 EXP, WITHOUT FIXING-

-CLINICAL TRIAL GOES TO ML AND DRUGS ARE DONATED NOT BEEN BILLED BECAUSE THE
PATROCINATOR HAS BEEN DONATED ARE FREE

*INSIDE RENOWN*

-UNDER DEPT SITES GO DOWN TO TRANSFORMATIONAL HEALTH CARE

(KAIZEN EVENT PLANING) LOOK FOR S’S

EXCERSICES:

(UNDER S’S) CLINICAL TRIALS SOMETHING IS AFECTING GREATLY

*NO SYSTEM ISSUES DOWN* (WHEN SOMETHING GOES CRAZY BY AMTS)

CLM EDITS, DNB’S, REBILLS, AD T STS

*CONTRACT’S NOT ALLOWED*

WHEN NRP’S AUTOMATICALLY/VS RESPONSE

-HOMEWORK-

-3 THINGS DOING MANULLY THAT I WISH TO BE AUTO

1. ADJ ACCURATE AND AUTO NRP

2. ABN CALCULATIONS AND CHK IF ACCURATE

3. AY MOD’S IF WE ALREADY KNOW THIS PT IS ON ESRD

4. HEALTH CARE OVER ADJ

-INSIDE RENOWN-

GO TOOLS-TASK TIME CALCULATION SHEET, CHK/PAY, HOW LONG IS THIS TAKING ME TO

DO 3 ACT’S AND TO GET PAID AND ALSO HOW LONG TO RESOLVE T STS, HOW LONG IS TAKING IT CLEAN
AND MED NEC , WE SHOULD NOT BILL KNOWING MED NEC SVC

-GO TO IDEA FORM; WASTE WHEEL, GUIDING TOOL, PROCESS IMPROVEMENT

RPIW=?

ML TRAINING 07.18.19
TO CHK NON COV SVC PG #C 2-3 ETC

CHK FOR MK NOTES THAT THEY HAVE THE CHARGES, SHE SAID ON HER NOTE

AY MOD’S CLMS IF REJECTED OR T’ED

WHEN IT SHOWS TPL OR NOT BEEN UPDATED FILE EVEN IF IS BEEN UPDATED BY PT, AND NOTIFIED US,
WE NEED TO CALL NORIDIAN AND CORNFIRM THAT ASKING IF WAS UPADTED LOCALLY OR NATIONALLY
FILES*

T’ED

*CHK CC, TOB, OVLP ISSUE ON EPIC , WE ARE SENDING A CORRECTED CLM, CHK ON NON COV ITEMS PG
2 ON THE ORIGINAL CLM*

-POW WOW 07.3019 ML/KH

EPIC UPDATE

TIER PROJECT, NEEDS TO BE FILTER THROUGH RB/CG

EPIC UPGRADE-USING A TIER

MAKE INDIVIDUAL RESEARCH BEFORE RB/CG?

WQ # 7167, 70158, 7184, 7185 IF MISSING

TIER=HEALTH CARE

NEED TO GO TO THE TOOLS WEB SITE, TODAY TRANSFORMATIONAL TOOLS*

SPAGUETTI CHART=DOCUMENT FOR ISSUES

-ASK KH=PH #

2HRS NOTICE PRIOR I FEEL SICK

-FMLA=PAID ON CASE NO OCC ISSUE, ASK IF IS FMLA MY CASE AND IF I CAN USE IT, IF HAVE TO BE
RELATED

I DO NOT GET PAID IF I DON’T HAVE HRS ONMY BANK, TO COVERS, TO DON’T GET FIRED=AS A PERMIT

TO GET INFO TPE TO TPE

ENTER INFO

THEN F8 AND F2 OR F8 AND F11 X 3

MEETING / TRAINING CG 07.30.19

>PG # 3 ON DDE, I CAN SEE DX CODES ON THE MIDDLE

FOR DELETE ON 03-23

I NEED TO DDD ON REV CODE, SCREEN SHOT THE IMAGEN BEFORE DELETING TO HAVE THE EXACT
VIEW)

I HAVE MESS UP, I HAVE TO RE ENTER THE NUMBER THE WHOLE LINE HOME+ENTER+TO WHEN I TAB

07.31.19
1. CHK FOR ADDING MICS GOV

2. CHK WHEN I ADDED CC TO SEE IF TAKE IT

MEETING 08.06.19 CG/RB

WHEN AMBIGUOS SEX ISSUE, NEED TO TELL CG/RB

-TRANSGENDER-

KEEP AND EYE ON BEHAVIORAL, NEEDS SPECIAL MANAGE BY LEADS

SOME SVC’S NEEDS TO BE BILLED SEPARATELLY EXP CPT CODE 90853<SEPARTELLY

WE NEED ALSO FIX THE DOS ON TOP BOX 6 MAKE SURE (NON BILLABLE)

ACCT CLASS BPHP/ HAS TO SAY PARTIAL HOSPITALIZATION

CC 41 AND RECCURING, PHP/SPLIT EVERY 7 DAYS, 20 HRS PER WEEK.

HOSPICE TO ASHLEY, TOB 821 ADD TO ASHLEY’S WQ

HOSPICE POW WOW 08.07.19
-SOLICITATE RN FOR A HOSPICE REVIEW ON EVERY SINGLE ACCOUNT EVEN IF IS A LAB SVC, DOESAN’T
MATTER THE AMT, WE NEED TO ADD IT TO THE RN WQ

08.08.19 CG
EXP: 17691168

MCR DOESN’T PAY FOR OBSERVATION HRS AND WE DO NOT EXPECT REIMB , WILL GO TO 3011, TO SEE
HOW THIS CLMS WERE BILLED , I NEED TO GO TO LIAB BUCKET, VIEW CLM AND HIT VIEW DETAILS AND
SEE HOW’S THE AMTS WERE BILLED AND FOR HOW MUCH…

*HUDDLE 08.14.19*
EXP;

-4511374, 5327106, 1030427

 ABN, HAS TO BE 25% MORE OR LESS OF THE DIFFERENCE, 80% OF THE TOTAL, ALLOWED (BY ML)
FROM 07.01.19 MUST BE OK, IF NOT CORRECT, NEED EXP’S

 BY ML, IF CLM DELETED FROM SSI OR NOT BEEN OUT FROM EIC, I NEED TO ADD WQ 5951, IF I HAVE
TO RE BILL AND AMT’S ARE ON PRE BILLED BUCKET I NEED TO ADD THE BI 23 TO HAVE MK

-TO BILL AS NEW

-SEND TO MK NOTES I USE FOR HER @2 PM

-ANOTHER WAY TO SEE NOTES, GO TO GUARANTOR SUMMARY AND CHOSE THE NOTE LIAB, NOT TOO
MANY USELESS NOTES.

MEETING 08.14.19
 BILLING FOR CC 07 MUST BE ADDED TO 5951 FOR BILLING MK, UNLESS IS CLOSE TO TIMELY FILING
(PER ML)

TO VERIFY COV MOVE THE TAB ON RIGHT (OPEN) AND CHK IF THEY WERE VERIFIED

EXP ACCT’S, ADJ AS 3011 THE REMAINNING BAL (PLB=RECOUPMENT) (PER VG)

PER ML NEEDS TO BE REPORTED TO CG OR KH

VIEW ALL BY POST DATE G0461 AND CHK IF PATHOLOGY, THAT IS FROM THE 2014 ISSUE

ABOUT ELIGIBILITY CHK THE OLD AND NEW # HOW TO LOOK FOR MID # DOS 07.28.19 MIGHT BE
WRONG EDIT AND NOT GETTING THE UPDATE

*FEEDING TUBE MCR PAYS FOR –NOT HOSPICE STAY-

BRING THE ACCT TO CG ABOUT HOSPICE THAT RB DID NOT HELPED AND/OR ASKED CHAD*

-CHK DEFERAL ACCT’S EVERY WEEK (PER ML) AND NOTE IT IF NEED IT
***RENOWN CCD.005 POLICY FOR ABN, CC 32 MEANS WE HAVE ABN ON FILE***

PROJECT PENNY CG 08.16.19

-PROJECT FROM CG, SPREAD SHEET INSTRUCTIONS*

CHK UNITS, AND BE SURE THAT I HAVE ALL NON COV $0.01, THE SAME AMT ON SSI, ON NON COV,
ANYTHING WTH THE PENNY, CLM’S FROM 08.12.19 NOT ON DDE, CHK UNITS RESUBMIT ON EPIC, UNITS
CORRECT, PENNY MOVED TO NON COV

MARK THE ONES CG, NEED TO BE WORKED, ALSO CHK THE AMT ON SSI AS REFERENCE AND CORRECT IF
NECESSARY ON EPIC, EDIT VALS, RESUBMIT ON BAB.

CG TRAINING FOR T STATUS 08.20.19

-ON AY MODS, ADJ AFTER, THEY PAID, TOOK, AND PAID

*AY IS JUST FOR COMPLAINCE, NOT FOR REIMB, WE DO NOT GOING TO GET PAID*

I NEED TO BE SURE I SBEEN PAID TWICE, 1 ST EOB NOT DENIAL+ ALL CONTRACTUAL IF MCR DO THEIR
OWN TAKE BACK, NOW I VAN ADJ AS 3011 AS PACKAGED.

MCR PAID, TAKED BACK ISSUE –CO 109-ESRD

SHORTCUT

SSI, SORT, GO AND RIGHT CLICK ON GO TO FIND (CORRECTIONS) HIT USING HIC, SVC DATES, AND STS,
AND WILL TAKE ME TO MY CORRECT PT

DENIAL CODE 37538 IS FOR AY MODS

DENIAL CODE C7117 IS FOR OVLP W/INPT SVC

138-CANNOT BE SUPPRESSED, LEAVE IT ON T-

HUDDLE 08.22.19 CG
-WHEN COMBINE ACCT’S, WE NEED TO ASK FOR OBSERVATION ALWAYS!!!!

-HOSPICE, IF WE CANNOT DERTEMINE IF IS RELATED OR NOT, AND WE WILL WORK ON THIS WITH VG

-I NEED TO KNOW W/CINDY ABOUT MY NOTES, ABOUT MY DENIALS, I NEED TO SEE FOR ME.

-WORKING T STS THRU SSI

F3, F3 REFRESH SSI

TRAININIG CG 08.28.19
13Q I NEED REMARKS, CHK DCN# (WHEN PASSED THE TMELY FILING)

13Q I NEED CC D9, R7, W2 ALWAYS REMARKS (GOOD CAUSE-C-A OTHER BECAUSE CWF IS UPDATED)

NOTES MUST BE HAVE WHEN, WHAT, HOW REASONS (PER DIRECTOR)

09.03.19
ALL PET SCANS NEED MODS PIU OR PS, IF THEY DO NOT HAVE, DO NOT SUPP CLM, ON DDE, JUST GIVE IT
TO CG*

***MEETING CG/RB 09.05.19***

KS MOD=EVEN IF DON’T MED NEC, WE PROMISE IT IS 6433 WQ, MOVE AND SUPP

LATE CHARGES-INITIATE BILLING

HUDDLE CG/RB 09.12.19

FROM NOW ON SOLICITATE A MEETING FROM LEAD BY APP ON OUTLOOK, ADD DESCRIPTION OF THE
ACCT’S WE WILL SEE.

NO ANSWER QUESTIONS FROM ANYBODY, LEADS WILL DO IT, JUST WORRY ANOUT MY WQ’S

 WRITE DOWN ANY ISSUE AS PROOF FOR VG, LIKE ELIGIBILITY

MCR FOLDER (ELIGIBILITY TOOLS) WEB SITE TO HAVE THE TOOL SHEET

CHEMO REMAIDER; BY RB

Whenever this T status reason code fires, it has to do with charges under 636 and 260 or
331/335.
Basically, there is an issue with a drug we charged, and how the administration is coded.
Admin codes are normally charged under Rev cd 260 or 331/335. I don’t see either of those
charges so acct would need to be reviewed by RI. 
this is an example
what about the 331/335
any of this should be good too
RB TRAINNG 09.25.19
WHEN CLM PARTIALLY DENIED AS NON MED NEC, MUST BE BECAUSE THE NONO COV AMTS
DON’T MATCH, I NEED TO CHK 1ST THE 1ST BILLED CLM AND DETERMINE WHAT AND WHICH
CODE WHERE DENIED, AND FIX IT ON DDE IF IS NOT BEEN SUPP, , I NEED TO GO TO F8 AND
THEN F6 AND MOVE THE AMT’S BACK NON COV, ALL THIS MUST BE FIXED ON 03-23 AND AT
THE END F9’ED, NOT SUPP
ON T STS PAGE, I CANNOT CHANGE THE DCN# BUT ALL THE OTHER INFO I CAN, .