What To Do With This

  • What to do with “ADN’S and “RDN’S”

ADN is attention all denial needed, claim requires all denial from private insurance or Primary prayer before it will be sent to main payor. RDN is Medicare denial needed, it requires a denial first from medicare before advancing to the Secondary payor. This status is usually on claims that is recently sent by our system. System send it at the same time and some insurance needs a denial first from the primary payor. As soon as denial from the private insurance and medicare has been received claim can now be send as RB NW to Secondary Payor. Some private insurance is paying the item at below our expected amount, but as the insurance paid it in full no need to send the bill to the secondary payer.

Primary – HMO’s, private insurances
Secondary Payer – MCO’s Medicaid, CHC’s

Do’sClick on the Rebill Order. On the rebill screen, select the insurance plan which needs to be rebilled. Highlight the item and click submit order as new claim.

Don’tDon’t send claims as RB NW if item is already fully paid. Make sure correct insurance plan is selected on the rebill screen.

  • What to Do with “IB-AN” or “Initial Billing Attention Needed”

IB-AN means something went wrong with billing, depending on how long that line item or order reflected that status, there is a possible chance that line item or order was never billed.

Do’s Check claim to the insurance if billing was received using there online web portals, Navinet or state websites. If the claim was never made to the insurance company, marked the item as RB NW.

Don’t – If claim was received by insurance no action needs to be done. Setting the claim or order as RB NW will result to claim duplication.

  • What to Do with “IB-WT” or “Initial Billing Wait”

IB-WT means system is waiting for a response from the insurance company. But be aware of the time frame the line item or order is resting on IB-WT, because there could be an issue.

Do’s – Have an estimated frame of Three to Four months after the claim or 837 file was sent. Medicaid Plans has a estimate time frame of a month and a half, the medicaid plans are pretty quick with a response if they denied a claim. Typically you will received a payment response four to five weeks after the insurance had processed the claim.

Don’t – If claim was received by insurance no action needs to be done. Setting the claim or order as RB NW will result to claim duplication.