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CLAIM DENIALS

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    Claims
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  • WHAT SCREEN DO YOU USE TO FIND THE DENIAL CODE REASON
    EOB/EOP MSGS
  •  25
  • WHAT DOES CT AT THE END OF THE DENIAL LINE REPRESENT IN THE EOP/EOB SCREEN
    COTIVITI
  •  10
  • WHAT IS THE REASON FOR DENIAL CODE EXIL?
    INPT.ADMISSION NOT PRIOR APPROVED,CONTRACT PROVIDER DO NOT BIL
  •  15
  • What message is associated with denial code Ex 08?
    PRIMARY INSURANCE EOB REQUIRED FOR PAYMENT CONSIDERATION
  •  5
  • What denial ex code is associated with message: EXCEEDS PLAN GUIDELINES,CONTRACTING PROVIDERS DO NOT BILL MEMBER?
    EX 56
  •  20
  • WHAT IS THE DENIED AMOUNT FOR CLAIM 221229M23211?
    76.03
  •  25
  • When receiving denial Ex code 25, what is the appropriate/corresponding advice?
    USED WHEN MEDICAL JUSTIFICATION IS REQUIRED BUTNOT PROVIDED. ADVISE PROVIDER TO SUBMIT OFFICE NOTES/MEDICAL RECORDS
  •  15
  • WHAT TWO PLACES CAN YOU LOCATE A MEMBERS APPEALS RIGHT FROM A CLAIM DENIAL
    FROM DENIAL LETTER OR KMT
  •  10
  • WHAT OTHER SCREEN CAN YOU LOCATE DENIAL CODE AND REASON?
    RF0300
  •  20
  • A POST SERVICE DENIAL CAN BE TAKEN OVER THE PHONE. TRUE OR FALSE?
    FALSE
  •  5