Submit as New Claims VS. Adjust
- Always remember that gloves cost $8 only for 1 unit, if it is more than $16, RECALCULATE.
- Always look for the order date and date billed of HCPCS.
- We can only bill for now are the A4927 (gloves) and the T Codes.
- Work only with the claims that has status ATTENTION NEEDED.
- Always remember if there is no payment in both IN-SENT and IN-BILLING and it’s 6 months or less REBILL-NW but if it’s more than 6 months affix the ICN # to prove that it was initially billed then bill as RB-NW.
- NPAN,PPAN NO PAYMENT, NO CLAIM NUMBER
- Submit as new claim if it is within 6 months period and the status will change RB-NW.
- NPAN,PPAN A4927AND T-CODES HAVING THE SAME REFERENCE CLAIM NUMBER WITH PAYMENTS IN IN-SENT AND IN-BILLING:
- Recalculate hit Re-bill and submit VOID/REBILL ORDER (ADJUST) if within 6 months or over.
- NPAN,PPAN WITH PAYMENT ON THE IN-SENT RECEIVE AND NO PAYMENT ON THE IN-BILLING
- Recalculate first then Re-bill as NEW CLAIM and the status will change RB-NW.
- OP,AN STATUS
- Always recalculate and the status will change ti FP-CP.
- NPAN,PPAN WITH PAYMENT ON THE IN-BILLING but NO CRN ON THE IN-BILLING BUT WITH CRN IN THE IN-SENT.
- Recalculate then copy the CRN to the IN-BILLING status.
- If there was NO AMOUNT PAID on the in-billing status, but there was a payment on the in-sent received; recalculate first then copy CRN number from the in-sent received then copy and paste it to the in-billing status then re-bill as VOID/REBILL ORDER (ADJUST) if it is within 6 months or over.
- IB-AN – INITIAL BILLING ATTENTION NEEDED
- Need to have CRN on the in-sent received before you re-bill this status, need an initial denial.
- Initial denial will be seen on the in-sent received using an adjustment code.
FOR MORE THAN 6 MONTHS
- Always check on the sale price on the order detail and expected amount in the billing order status; if the two has the same amount click the UPDATE EXPECTED PAYMENT the RECALCULATE PAYMENT.
- For claims that has NO PAYMENT both in the billing status and in-sent received and the CRN is different from others, it is okay to re-bill the order submit as NEW CLAIM.
- for the ADJUSTMENT of claims make sure that this is a payment that can be adjusted.