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WorksheetsPatient not eligible for Date of service- QUIZ
Total questions: 10
Worksheet time: 4mins
What can we also name Patient is not eligible on DOS scenario?
Coverage is not effective
Member is not active on DOS
Expenses incurred prior to coverage
All of the above
What is the denial code for Patient is not eligible on DOS?
PR 21
PR 26
PR 25
PR 23
If the claim with date of service - 05/01/2023 is billed to insurance and the patient's policy was effective from 05/15/2022 and is still active then will the claim be denied for coverage terminated?
Yes
No
May be
If the claim is denied as Member is not active on DOS, Effective date is : 01-01-2022, Termination date is : 12-31-2022.DOS: 07-01-2022. what will be the next action?
Send Appeal
Send the corrected claim to Insurance
Send the claim for reprocessing
Adjust the claim
There is no need to ask for claim# if there is EOB available in the software?
Yes
No
May be
Can we bill the patient is there is secondary insurance active on DOS?
Yes
No
May be
What are the other denial codes for Member is not eligible on DOS?
CO 26
CO 27
CO 28
All of the above
We should always check the previous notes if the claim for the same patient and member was active by the same insurance, if paid we can call the ins and send the claim for reprocessing/resubmit the claim after checking eligibility?
Yes
No
May be
Is CO-31 same scenario as Member is not active on DOS?
Yes
No
May be
If the claim is denied as CO_26, CO_27, or CO_28, and rep advised to send the corrected claim, Can we send the corrected claim to Traditional MCR and MCD?
Yes
No
May be
