09/13/2021

ERL Rejections: CLAIM SUBMITTED TO INCORRECT PAYER ENTITY

Action taken: Member is ineligible per BT. Eligibility End Date 04/15/2021. Termed
INS. WIP'd SO to RCM - INS Issue

583342
ERL Rejections: ENTITY'S DATE OF BIRTH ENTITY- PATIENT
Action taken: Pt's name/DOB matches the info in documents. Previousy updated
correct name and was resubmitted but still rejected. Resubmitted claim as print.
Closed ERL

ERL Rejections: MISSING OR INVALID INFORMATION ENTITY- PAYER

Action taken: Member is eligible. Resubmitted claim as print. Closed ERL

599318
ERL Rejections: DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LIN
Action taken: Per note 315214, REP sts NCOF and advised to resubmit but still
rejected. Member is eligible. Resubmitted as print. Closed ERL

616841

ERL Rejections: DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE. - PAYER

Action taken: Claim has been paid just waiting to be posted. EOB is attached to
invoice. Closed ERL

619612
ERL Rejections: Other Carrier Claim filing indicator is missing or invalid.
Action taken: Updated filing code to Commercial Insurance. Resubmitted the claim.
Closed ERL

628907
ERL Rejections: ENTITY'S DATE OF BIRTH ENTITY- PATIENT
Action taken: Updated name to VUKSICH II, MALCOM M from VUKSICH, MALCOM M. Member
is eligible. Resubmitted the claim. Closed ERL

632463 - EMAIL
ERL Rejections: CLAIM SUBMITTED TO INCORRECT PAYER ENTITY- PAYER
Action taken: Per Note ID326418, Member inactive for the DOS. Emailed pt
[email protected] to verify new INS info. Sent to INS issue. Closed ERL

629907
ERL Rejections: SERVICE FACILITY ZIP CODE IS MISSING OR INVALID
Action taken: Previous submission still unsuccessful. Updated Type as Branch office
for Rendering provider. Resubmitted claim. Closed ERL

632562
ERL Rejections: ENTITY'S DATE OF BIRTH ENTITY- PATIENT
Action taken: Updated name to SCHADLER JR, GERALD F from SCHADLER, GERALD F Member
is eligible. Resubmitted the claim. Closed ERL

629909
ERL Rejections: SERVICE FACILITY ZIP CODE IS MISSING OR INVALID
Action taken: Previous submission still rejected. Updated Type as Branch office for
Rendering provider. Resubmitted claim. Closed ERL

634178
ERL Rejection: SUBSCRIBER AND POLICY NUMBER/CONTRACT NUMBER NOT FOUND ENTITY-
PAYER
Action taken: Member is ineligible per BT. Policy Expiration Date 08/31/2021. No
email on file. Sent to INS issue. Closed ERL

633890
ERL Rejection: CLAIM CONTROL NUMBER REQUIRED WHEN EITHER THE COB PAYER
ERL Rejection: Primary claim not yet paid nad was denied. Reveresed the bal back to
primary. Closed ERL

634383
ERL Rejection: APPROPRIATE MODIFIER IS REQUIRED, KJ, KX
Action taken: Modifier updated resubmit the claim electronically. Closed ERL

634404
ERL Rejection: SERVICE DATE- INVALID; MUST BE LESS THAN OR EQUAL TO TRANSACTION
SET CREATION DATE
Action taken: Modifier updated resubmit the claim electronically. Closed ERL

636673
ERL Rejection: THIS CODE REQUIRES USE OF AN ENTITY CODE. - PATIENT
Action taken: Submitted claim as print. Closed ERL

638565
ERL Rejection: Acknowledgement/ Returned as unprocessable claim
Action taken: Modifier updated resubmit the claim electronically. Closed ERL

09.14
632335
ERL Rejection: MISSING OR INVALID INFORMATION ENTITY- PAYER
Action taken: Member Ineligible during DOS 12/04/2020 with Policy ID
ZLO210015012. Emailed pt [email protected] to verify active sec INS
during DOS. Sent to Insurance Issue

628909
ERL Rejection: ENTITY'S DATE OF BIRTH ENTITY- PATIENT
Action taken: Previous resubmision still rejected. DOB is correct. Member is
eligible. Resubmitted claim as print. Closed ERL

637560
ERL Rejection: PAYOR ID MISSING/INVALID
Action taken: Updated submission type to Commercial. Resubmitted claim. Closed ERL

ASK LANIE
637926 - REMOVE BRANCH IN CLINICAL
ERL Rejection: RENDERING DATA MISSING OR INVALID
Action taken: Removed type as branch office in clinical tab. Resubmit the Claim
electronically. Closed ERL

638924 OXYGEN
ERL Rejection: Returned as unprocessable claim
Action taken: Previous claim was processed with no modifier. -Invoice 622795.
Removed modifier and resubmitted the claim. Closed ERL

MUTUAL OF OMAHA
Claim status: NCOF
Source: Portal
Action taken: Member is Eligible. Resubmitted claim

619107
MUTUAL OF OMAHA
Claim status: Partially paid
Update: Found payment info in portal for A7038 paid for $3.49
Claim#: 585441580200 018
Processed date: 2021-08-25
Check#: 31976686
Paid to: Sleep Technologies LTD

09/14/21 MT -
INS: OHSU Health Services
Denied for no Auth. Need to obtain retro auth to avoid future denials. WIPd to RCM
PAR Needed.

ref Note ID230006

457089
INS: OHSU Health Services
Claim has been paid and posted. EOB is attached. No denial. Adjustment applied

33116650-24.

INS: ALLIED BENEFIT SYSTEMS

Source: Portal
Claim#: 3311665024
Processed date: 5/24/2021
Claim was processed and applied to Deductible. Uploaded EOB. Balance billed pt

3311665020.
457813
INS: OHSU Health Service
Issue: Claim was denied as coverage Policy termed, and Policy termed on 12/31/2019

227594
Claim has been paid and posted. EOB is attached to Deposit. No denial. Adjustment
applied.

09/15/2021 Manilyn M

TRICARE-WEST REGION CLAIMS (INS011)

Issue: In ref to Note ID216300 - Per rep appeal was not receive however rep sent
the claim back for review since the denial is incorrect.
Phone#: (844)866-9378
Call ref/ Trans#: 202125824114598
Update: Spoke with Jasmine said claim was not sent back and was advised to fax
Medical records for reconsideration. Fax#: 8447301371. No SS, progress note
available. Submitted MR request to Ordering doctor via fax

Trans#: 202125824114598

Jasmine

Medical necessity note -

It was not sent back.

Call ref#: Jasmine09152021

CARE OREGON OHP

Denial: Auth is required for E0470
Update: Per last note, Insurance allows providers to submit retro authorization
requests. can be obtained via Paper. WIPd to RCM - PAR needed

CARECENTRIX
Issue: Need compliance report to process the claim. Obtained compliance from Care
Orchestrator portal. PT is compliance. Submitted mail request to David L and Patty
W along wIth MR.

476464
Issue/Denial: Denied for Auth. Approved auth for E0601 is 71391567 valid from
1/16/2020 - 05/14/2020
Action taken: Spoke with Laurine, Said plan of pt is handled by Cigna. Called CIGNA
8002446224 but unable to speak to live rep, requested callback.
Called ref#: Laurine09152021

8002446224

Cigma pt

8002446224
8002446224

angie09152021

CARECENTRIX
In ref with Note ID 186326, states 'Received response stating "Tasking back to RCM
Please review for adjustment, past 120 days to obtain retro auth" Therefore sent to
adjustment'
Adjustment applied

555581
HUMANA MEDICARE SUPPLEMENT
Issue/Denial: Svcs not authorized by N/W or providers. We are out of network in ref
with Note ID 169733 therefore PAR is needed. Task is open under NOTE ID# 246079.
WIPd to RCM - PAR Needed
Fax# 5031468118

488247
CARECENTRIX
Issue/Denial: Per PAR note in SO 100122 - PT is non compliant unable to obtain auth
for machine rental ext.
Action taken: Balance billed to pt

488323
509763
REGENCE BCBS
Issue/Denial: Need to submit compliance report to prove medical necessity for
appeal. Pt is compliance. Faxed compliance report and MR to 866-273-1820

OHSU Health Services

ERL Rejections: SERVICE FACILITY ZIP CODE IS MISSING OR INVALID
Action taken: Coordinated with LP. Advised to resubmit

Write-Off, Prior Auth Not Obtained

443598
441117
450974
459821
REGENCE BCBS MED ADVANTAGE
Phone#: 800-448-0525
Call ref#: 212590001697
Update: poke with Jeremy, adv they were nable to complete the review for Medical
records since they still have not received a copy of the DWO (signed before
delivery) & the DT for the DOS. Rep advised that TF is 18 months from original
denial date. Claim is already past timely. Adjustment applied

487645
496635
REGENCE BCBS MED ADVANTAGE
Claim still in process in Availity. Claim 124252099P50H 00

533955
518335
524809
534106
541903
547922
REGENCE BCBS MED ADVANTAGE
Checked Availity. No updated claim available. Recently submitted MR via mail by
rep. Allow more time for processing. Claim E52150400300

514952
520768
530013
Updated invoice plan to REGENCE BCBS MED ADVANTAGE -PT policy was termed on
11/05/2020. We need AUTH to submit claim, TFL is 1 yr from DOS. Submitted to
correct payer since its almost past timely. Still, WIPd to RCM PAR Needed.

REGENCE BCBS MED ADVANTAGE

PT policy was termed on 11/05/2020.
Called pt @(503)975-1704 and left VM.
email PT [email protected].
2nd Attempt**

REGENCE BCBS MED ADVANTAGE

Denied for Auth. Retro auth is needed.
Please obtain if possible. WIPd to RCM - PAR Needed

OHSU Health Services

Member Ineligible during DOS - Need to verfify active plan during DOS. Left VM. and
emailed pt at [email protected] to verify INS info

566124
Claim has been paid and applied to invoice under Deposit - 41246. Allow more time
for posting

Per last note, INS rep stating that the PT last name is incorrect for the DOS.
Contacted pt @(360)953-4870 to verify info and so pt can update ins. Left VM

Requested valid MR for DOS via fax# (360) 991-0291 with Ordering Doctor's office
ROSEN, PREETHA S

Patient ID23572
INS: Health Alliance Plan (HAP) of Michigan
Update: In ref with Note ID 327096, Cindy Mars from INS called informing that pt
coverage was termed on 12/31/2020. Need to reach out to pt for her current health
coverage information. Task 327377 is open.
Sent an email to to pt [email protected]

640518
Claim was rejected for Dx. Updated G47.33 as the primary Dx. Resubmitted the claim.
ERL closed

639895
Claim rejected as CLAIM LEVEL RENDERING DATA MISSING OR INVALID. Rendering provider
matches the info in SO and Rx. Closed ERL and resubmitted the claim
637560

Claim rejected as incorrect - found payor ID in website for Medical as 13350.

Updated from 17013 to 13350. Resubmitted the claim

639953
Claim rejected as CLAIM LEVEL RENDERING DATA MISSING OR INVALID. Rendering provider
matches the info in SO and Rx. Closed ERL and resubmitted the claim

632593
No secondary Ins. Primary already processed the claim. Termed sec INS info in BT
and transferred coins to pt. Closed ERL

MODA 637560
OHSU Health Services 629909
Claim still rejected as incorrectfacility zip code. Found paid claims has payor ID
13350. Updated from 17013 to 13350. Resubmitted the claim. Closeed ERL

623504
Claim rejected as CLAIM LEVEL RENDERING DATA MISSING OR INVALID. Found paid claims
has payor ID MC015. Updated from 17013 to MC015. Resubmitted the claim. Closeed ERL

620836
Claim rejected as CLAIM LEVEL RENDERING DATA MISSING OR INVALID
Found paid claims were submitted with no branch stated ni Clinical tab. Removed
type as branch office. Resubmitted the claim

595737
Claim rejected as OTHER PAYER ADJUSTMENT REASON CODE IS MISSING OR INVALID. Found
paid claims were submitted as print. Closed ERL and resubmitted claim as print

Patient ID 15339
DMAP - OREGON MEDICAID.
Found no claim in Portal. Meber is active. Claim was just recently opened
09/01/2021 submitted via mail. Therefore, allow more time for processing.

DMAP - OREGON MEDICAID

No claim found in portal. Member eligible. Resubmitted claim

Patient ID30473
Denied in portal as Patient/Insured health identification number and name do not
match. Pt has Middle initial M. Updated name and resubmitted corrected claim.
Claim# 2021223025329

No claim found in portal. Pt has Middle initial M. Updated name and resubmitted
corrected claim

DMAP - OREGON MEDICAID

No claim found in portal. Member eligible. Resubmitted claim