Commercial – Baptist Working Procedure
Follow the below procedure while working on the denial AR workfile for the scenarios mentioned below
The charges have been applied to Deductible
Post the deductible with contractual disallowed for contractual carriers & full billed amt for non contracted carriers if the claim number is obtained & duplicate eob is requested.
The insurance company does not recognize a subscriber
Do all the possible researches with eligibility websites, DT Sheet. If still no information found then bill the balance to patient, inactivate the denied carrier & change the financial class to SP.
Not primary insurance
Check DT sheet for Primary Insurance information. If two carriers are found in the insurance screen, interchange the carrier & refile the claim with appropriate financial class. If there is only one insurance and unable to determine primary coverage (Insurance denied this charge stating you have primary coverage with another carrier.) and if unable to obtain other insurance information from the denied carrier representative then bill the balance to patient after verifying the source documents.
Your insurance states there are no benefits for this expense
Balance bill to patient after verifying with insurance representative for patient benefits.
Not covered at time of service
If there is two insurance, then inactivate the primary after confirming the termination date. Update the secondary insurance as primary & refile the claim with appropriate FC. Insurance states we were not eligible for coverage at the time service was rendered. Then bill the patient, self pay the account & inactivate the termed carrier. If the EOB gives coverage dates check patients account for other dates of service that are not covered and process in the same manner.
Insurance is requesting information (accident details) from the patient
Check with Insurance Rep...
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