Resolving EDI Errors

Tips for Resolving Errors with 270/271 Eligibility and Benefits Transactions UnitedHealthcare wants to help partners resolve errors to obtain member eligibility and benefits from their 270/271 Health Care Eligibility and Benefit Inquiry and Response transactions. Its current search logic allows you to enter different criteria related to the member or patient for the eligibility and benefits inquiry transaction Read More →

HIPAA training

Fraud, Waste and Abuse (Louisiana Healthcare Connections) Some of the most common coding and billing issues are: Billing for services not rendered Billing for services at a frequency that indicates the provider is an outlier as compared with their peers. Billing for non-covered services using an incorrect CPT, HCPCS and/or Diagnosis code in order to Read More →

HIPAA training

Louisiana Healthcare Connections Claims Appeal In order to file an appeal the provider must have received an unsatisfactory response to a request for reconsideration. Submit the following items when filing an appeal: Claim Appeal Form ( Original Request for Reconsideration letter and response Any supporting documentation supporting the request for an appeal The medical records Read More →

Claims Disputes

Claims Disputes Requests for Reconsideration of a Claim All claim requests for claim reconsideration must be received within 180 calendar days from the date of notification of payment or denial was issued. A Request for Reconsideration is a communication (i.e., a typed letter) from the provider about a disagreement in the way a claim was Read More →