Eligibility

What is the reason code for eligibility denial?

• PR-22

• CO-24

• PR-27

• OA-18

In case of eligibility denial, we will first verify the policy eligibility on ?

• Claim form

• Insurance website

• denial EOB

• none of the above

If a claim denied for patient not eligible for coverage on DOS and user find the plan is active on insurance website then what should be the next course of action?

• Bill to patient

• Call the payer and challenge

• adjust the claim balance

• none of the above

Policy is effective from Jan 1st 2022 till Dec 31st 2022. Select the date of service on which patient policy is active.

• Dec 31st 2021

• Jan 1st 2023

• Oct 27th 2022

• Jan 16th 2019

What will be the follow-up if claim has been denied for member not Eligible on date of service.

• Check patient eligibility on payer website/call

• Bill to patient

• check the medical records

• adjust the claim balance

Payer has denied the claim for eligibility and policy is inactive on DOS. Is it necessary to remove inactive payer from host?

• Yes, it is necessary to remove the inactive payer from host.
• No, the inactive payer should remain for record-keeping.
• No, it is not necessary to take any action regarding the payer.
• Yes, but only if the claim is denied for other reasons.