AR MANUAL

ISSUES AND ACTIONS

Claimnot on file
Claims mailing address
Fax #
Whose attention the claim has to be faxed
Effective date
Timely filing period
Verify id and group #.
May I have the claims mailing address?
Could you please give me the fax # and can I go ahead and fax it your attention?
Is patient eligible for the DOS?
May I have the filing limit for this claim?
Claimin process
Date of receipt of the claim
Processing time.
Can I have the date on which the claim was received?
How long would that take to process this claim?
Claimforwarded to the payer from the pricing center
Date of forwarding of claim to the payer
Payer phone number.
Could you please tell me the date on which the claim was forwarded to the payer?
Can I know the phone number for the payer please?
Claimpaid
Check #
Check date
Paid amount
Allowed amount
Patient's responsibility
Write off
Pay to address
Cashed date
Could you please tell me the check # and check date?
How much was the allowed amount for the claim
Can you please tell me how much was paid for this DOS?
Are there any write off on this claim?
What would be patients responsibility?
Can you verify the pay to address for me please?
Was the check cashed?
Claimpaid to wrong address
Verify pay to address
Telephone appeal to update
W9 form
Cancelled check copy if cashed
If not, request for stop payment and reissue the check.
Could you verify the pay to address for me please?
Can you go ahead and update your records if I give you the correct pay to address for
the provider over phone?
Could you please give me the fax # and can I go ahead and fax W9 form to your
attention?
Please fax us a copy of the cancelled check if the check has already been cashed
 Could you please put a stop payment for this check and reissue the check to the
correct address?
Claim denied for untimely filing
Date of denial
Re-filing and appealing address
Verify timely filing limit
Fax number.
May I have the denial date and the filing limit for this claim?
Can I have the address where I need to appeal for this claim?
Could you please give me the fax # and can I go ahead and fax it to your attention?
Claim denied for eligibility
Date of denial
Effective/ termination date of coverage
EOB request
May I have the denial date for this claim?
May I have the effective / termination date of patients policy?
Could you please fax / mail me a copy of the EOB
Claim denied for non covered services
Date of denial
Details of the non covered service
Check if patient can be billed
EOB request.
May I have the denial date for this claim?
Could you please tell me the services that are not covered under this plan?
Can we go ahead and bill the patient for this claim?
Can I get a copy of this EOB faxed / mailed to me please?
Claim denied for EOB from the primary insurance
Date of denial
Information on primary insurance if the rep has with their system
Fax number
May I have the date this claim was denied?
Would you be able to re-process this claim if I were to fax you the Primary EOB?
Claim denied for cob
Date of denial
Information of the other insurance if they have on their file
EOB request
May I have the date this claim was denied?
Would you be able to tell me if the patient has any other Insurance?
Could you fax / mail me a copy of the EOB?
Claim denied for capitation
Date of denial
If possible date of Capitated contract
Request for EOB
May I have the date this claim was denied?
May I have the date of capitated contract?
Could you fax / mail me a copy of the EOB?
Claim denied for authorization number
Date of denial
Check if there is any auth in the software mentioned for the dos
Check if they have an auth on file for any hospital claim for the same dos
Fax number
EOB request.
May I have the date this claim was denied?
Could you please tell me if you see any authorization # for the same DOS for the
hospital claim?
 I have a authorization # in the system, could you re-process the claim if I give this
number to you now?
Would you be able to re-process this claim if I were to fax you the claim with
authorization number?
Could you fax / mail me a copy of the EOB?
Claim denied for referral
Date of denial
Check if there is any referral on the software mentioned for the dos
Check if provider is participating
Fax number
EOB request.
May I have the date this claim was denied?
I have a referral # in the system, could you re-process the claim if I give this number
to you now?
Would you be able to re-process this claim if I were to fax you the claim with referral
number?
Could you fax / mail me a copy of the EOB?
Claim denied as bundled/ incidental/ inclusive
Date of denial
Major procedure to which it has been bundled
Can we appeal with medical notes
Fax number
EOB request.
May I have the date this claim was denied?
Could you please tell me to which major procedure the claim has been bundled to?
Can I have the address where I need to appeal for this claim?
Could you please give me the fax # and can I go ahead and fax it to your attention?
Claim denied for referring physician
Date of denial
Ask if provider is the PCP
If not ask for PCPs name and phone number
Insurance fax number
EOB request.
May I have the date this claim was denied?
Would you be able to reprocess this claim if I give you the referring physicians name
and UPIN #?
Can I have your fax number?
Claim denied for incorrect provider
Date of denial
Correct provider info
Fax number
EOB request.
May I have the date this claim was denied?
I have the correct provider # in the system, could you re-process the claim if I give
you this information?
Can I have your fax number please?
Claim denied as primary paid maximum
Date of denial
Allowed amount
Verify the primary payment details
EOB request.
May I have the date this claim was denied?
May I know the allowed amount for this claim?
Could you please tell me how much did the primary paid on this claim?
Could you fax / mail me a copy of the EOB?
Claim denied for wrong diagnosis
Date of denial
Correct diagnosis code
Fax number
EOB request.
May I have the date this claim was denied?
Could you please tell me which is correct diagnosis for this procedure?
Can I have your fax number please?
Could you fax / mail me a copy of the EOB?
Claim denied for modifier
Date of denial
Correct modifier
Ask for fax number
EOB request
May I have the date this claim was denied?
Could you please tell me which is correct modifier for this procedure?
Can I have your fax number please?
Could you fax / mail me a copy of the EOB?
Claim denied for pre-existing condition
Date of denial
Pre-existing condition
EOB request
May I have the date this claim was denied?
Could you tell me the condition that was classified as pre-existing for this patient?
Could you fax / mail me a copy of the EOB?
Claim denied as not medically necessary
Date of denial
Appeal with medical notes
Fax number
EOB request
May I have the date this claim was denied?
Can I go ahead and send the appeal with medical notes?
Can I have your fax number please?
Could you fax / mail me a copy of the EOB?
Claim denied for untimely follow up
Appealing address
Verify timely follow up time
Fax number
May I have the date this claim was denied?
Can I go ahead and send the appeal with proof of timely follow up?
Could you tell me the follow up time for this claim?
Can I have your fax number please?
Claim denied as duplicate
Date of denial
Primary dos to which the claim is denied as duplicate
Appeal with medical notes
Fax number.
May I have the date this claim was denied?
Can I have the details of the primary procedure to which claim is duplicated?
Can I go ahead and send the appeal with medical notes?
Can I have your fax number please?
Claim denied as Offset
Date of denial, Offset dos details, Amount offset, EOB request
May I have the date this claim was denied?
Could you give the details of the DOS offset to?
How much was offset to?
Could you fax / mail me a copy of the EOB?
Claim pending for additional information
Details of the information required
Fax number
 Could you tell me the information required to process this claim?
May I have your fax number please?
Claim processed towards patient's deductible
Processing date
Provider in or out of network
Break up of the benefits
EOB request.
May I know the date on which this claims was processed?
Is the provider out of network?
Could you please tell me how much was processed towards the deductible?
Could you fax / mail me a copy of the EOB?
Claim paid to patient
Check if provider is participating
Payment details
EOB request.
May I know when was the claim paid to patient?
Can I know how much was paid to the patient?
Is the provider participating? Could you fax / mail me a copy of the EOB?