Additional Information

Reason Code for Missing Explanation of Benefits?

• N477

• N479

• N779

• None of the Above

Can we bill the claim to secondary insurance without receiving primary insurance EOB? 

• Yes

• No

Claim denied for additional info from patient we need to verify.

• Process update

• Dates and no. of letters sent

• TFL limit

• Letters sent to provider

To send a corrected claim what all information is required?

• Corrected Claims mailing address

• TFL for corrected claim

• Both A and B

• None of the above

To send an Appeal what all information is required?

• Appeal Limit

• Appeal address

• Fax# with attention

• All of the above

What does “Claim denied because insurance needs primary EOB” mean?

• Claim submitted to primary insurance without EOB

• Claim submitted to secondary without primary EOB

• Check if patient has other active insurance in CPM

• None of the above

What is the denial code for additional information?

• C0-19

• C0-20

• C0-16

• C0-06

If the claim is sent for reprocessing do we have to Rebill the claim again to insurance?

• True

• False

When a claim is denied for additional information, which is the suitable option?

• Bill the patient

• Call the insurance and ask what exactly is needed (is it from the provider or patient side) and work based on the denial

• Adjust the claim

• Rebill the claim

Is it mandatory to ask for a copy of EOB over the call with insurance representative, if EOB is not available in the available resources?

• Yes

• No