When you need to resubmit a claim, file an appeal, or send a corrected claim, use the Billing History in the patient’s chart to add claim resubmission information to the encounter and queue up a new claim. Step 1: Select the Encounter In the patient’s Billing History, select the encou...
Date of automatic resubmission In this field, enter the date of the automatic resubmission. This is the date on which the system triggers processing of the claim again. LOSSREP_DT Date on request for benefit In this field, enter the date on the request for the insurance bene...
MEDICAID RESUBMISSION CODE ORIGINAL REF. NO. 1. 3. 23. PRIOR AUTHORIZATION NUMBER 2. 4. 24. A B C D E F G H I J K N DATE(S) OF SERVICE Place Type PROCEDURES, SERVICES, OR SUPPLIES DAYS EPSDT RESERVED FOR O From To of of (Explain Unusual Circumstances) DIAGNOSIS OR Family I ...
resubmission OPTIONAL No entry required. 23 Prior authorization number SITUATIONAL REQUIRED if there is a prior authorization, enter the prior authorization number. Obtain the prior authorization number from the prior authorization form. 24A. Date(s) of ...
NOTE:Ifclaim(s)alsorequiredacorrection,suchasavalidprocedurecode,locationcodeormodifier,includeacopyofthatpagefromyourEOPwiththeclaimcircled,alongwithacopyofthenew,correctedCMS-1500orUB-04form,marked“RESUBMISSION”acrossthetop. Mailcompletedform(s)andattachmentsto: ...
accordance with the provisions of California Code of Regulations (CCR), Title 22 and policies established by the Department of Health Care Services. claim sub 7 1– Claim Submission and Timeliness Overview December 2009 Resubmission Turnaround A Resubmission Turnaround Document (RTD) is sent to pro...