Issue Codes Claim not on file Claim in process Claim forwarded to the payer from the pricing center Claim paid Claim paid to wrong address Claim denied for untimely filing Claim denied for eligibility Claim denied for non covered services Claim denied for EOB from the primary insurance Claim denied for COB Claim denied for capitation Claim denied for authorization number Claim denied for referral Claim denied as bundled/ incidental/ inclusive Claim denied for referring physician Claim denied for incorrect provider Claim denied as primary paid maximum Claim denied for wrong diagnosis Claim denied for modifier Claim denied for pre-existing condition Claim denied as not medically necessary Claim denied for untimely follow up Claim denied as duplicate Claim denied as Offset Claim pending for additional information Claim processed towards patient's deductible Claim paid to patient

Claim not on file Claims mailing address Fax # Whose attention the claim has to be faxed Effective date Timely filing period Verify id and group #. May I have the claims mailing address? Could you please give me the fax # and can I go ahead and fax it your attention? Is patient eligible for the DOS? May I have the filing limit for this claim?

Claim in process Date of receipt of the claim Processing time. Can I have the date on which the claim was received? How long would that take to process this claim?

Claim forwarded to the payer from the pricing center Date of forwarding of claim to the payer Payer phone number. Could you please tell me the date on which the claim was forwarded to the payer? Can I know the phone number for the payer please?

Claim paid Could you please tell me the check # and check date? How much was the allowed amount for the claim Can you please tell me how much was paid for this DOS? Are there any write off on this claim? What would be patient’s responsibility? Can you verify the pay to address for me please? Was the check cashed? Check # Check date Paid amount Allowed amount Patient's responsibility Write off Pay to address Cashed date

Claim paid to wrong address Could you verify the pay to address for me please? Can you go ahead and update your records if I give you the correct pay to address for the provider over phone? Could you please give me the fax # and can I go ahead and fax W9 form to your attention? Please fax us a copy of the cancelled check if the check has already been cashed Could you please put a stop payment for this check and reissue the check to the correct address? Verify pay to address Telephone appeal to update W9 form Cancelled check copy if cashed If not, request for stop payment and reissue the check.

Claim denied for untimely filing Date of denial Re-filing and appealing address Verify timely filing limit Fax number. May I have the denial date and the filing limit for this claim? Can I have the address where I need to appeal for this claim? Could you please give me the fax # and can I go ahead and fax it to your attention?

Claim denied for eligibility Date of denial Effective/ termination date of coverage EOB request May I have the denial date for this claim? May I have the effective / termination date of patients policy? Could you please fax / mail me a copy of the EOB

Claim denied for non covered services Date of denial Details of the non covered service Check if patient can be billed EOB request. May I have the denial date for this claim? Could you please tell me the services that are not covered under this plan? Can we go ahead and bill the patient for this claim? Can I get a copy of this EOB faxed / mailed to me please?

Claim denied for EOB from the primary insurance Date of denial Information on primary insurance if the rep has with their system Fax number. May I have the date this claim was denied? Would you be able to re-process this claim if I were to fax you the Primary EOB?

Claim denied for cob Date of denial Information of the other insurance if they have on their file EOB request. May I have the date this claim was denied? Would you be able to tell me if the patient has any other Insurance? Could you fax / mail me a copy of the EOB?

Claim denied for capitation Date of denial If possible date of Capitated contract Request for EOB May I have the date this claim was denied? May I have the date of capitated contract? Could you fax / mail me a copy of the EOB?

Claim denied for authorization number Date of denial Check if there is any auth in the software mentioned for the dos Check if they have an auth on file for any hospital claim for the same dos Fax number EOB request. May I have the date this claim was denied? Could you please tell me if you see any authorization # for the same DOS for the hospital claim? I have a authorization # in the system, could you re-process the claim if I give this number to you now? Would you be able to re-process this claim if I were to fax you the claim with authorization number? Could you fax / mail me a copy of the EOB?

Claim denied for referral Date of denial Check if there is any referral on the software mentioned for the dos Check if provider is participating Fax number EOB request. May I have the date this claim was denied? I have a referral # in the system, could you re-process the claim if I give this number to you now? Would you be able to re-process this claim if I were to fax you the claim with referral number? Could you fax / mail me a copy of the EOB?

Claim denied as bundled/ incidental/ inclusive Date of denial Major procedure to which it has been bundled Can we appeal with medical notes Fax number EOB request. May I have the date this claim was denied? Could you please tell me to which major procedure the claim has been bundled to? Can I have the address where I need to appeal for this claim? Could you please give me the fax # and can I go ahead and fax it to your attention?

Claim denied for referring physician Date of denial Ask if provider is the PCP If not ask for PCP’s name and phone number Insurance fax number EOB request. May I have the date this claim was denied? Would you be able to reprocess this claim if I give you the referring physician’s name and UPIN #? Can I have your fax number?

Claim denied for incorrect provider Date of denial Correct provider info Fax number EOB request. May I have the date this claim was denied? I have the correct provider # in the system, could you re-process the claim if I give you this information? Can I have your fax number please?

Claim denied as primary paid maximum Date of denial Allowed amount Verify the primary payment details EOB request. May I have the date this claim was denied? May I know the allowed amount for this claim? Could you please tell me how much did the primary pay on this claim? Could you fax / mail me a copy of the EOB?

Claim denied for wrong diagnosis Date of denial Correct diagnosis code Fax number EOB request. May I have the date this claim was denied? Could you please tell me which is correct diagnosis for this procedure? Can I have your fax number please? Could you fax / mail me a copy of the EOB?

Claim denied for modifier Date of denial Correct modifier Ask for fax number EOB request. May I have the date this claim was denied? Could you please tell me which is correct modifier for this procedure? Can I have your fax number please? Could you fax / mail me a copy of the EOB?

Claim denied for pre-existing condition Date of denial Pre-existing condition EOB request. May I have the date this claim was denied? Could you tell me the condition that was classified as pre-existing for this patient? Could you fax / mail me a copy of the EOB?

Claim denied as not medically necessary Date of denial Appeal with medical notes Fax number EOB request May I have the date this claim was denied? Can I go ahead and send the appeal with medical notes? Can I have your fax number please? Could you fax / mail me a copy of the EOB?

Claim denied for untimely follow up Appealing address Verify timely follow up time Fax number. May I have the date this claim was denied? Can I go ahead and send the appeal with proof of timely follow up? Could you tell me the follow up time for this claim? Can I have your fax number please?

Claim denied as duplicate Date of denial Primary dos to which the claim is denied as duplicate Appeal with medical notes Fax number. May I have the date this claim was denied? Can I have the details of the primary procedure to which claim is duplicated? Can I go ahead and send the appeal with medical notes? Can I have your fax number please?

Claim denied as Offset Date of denial Offset dos details Amount offset EOB request. May I have the date this claim was denied? Could you give the details of the DOS offset to? How much was offset to? Could you fax / mail me a copy of the EOB?

Claim pending for additional information Details of the information required Fax number. Could you tell me the information required to process this claim? May I have your fax number please?

Claim processed towards patient's deductible Processing date Provider in or out of network Break up of the benefits EOB request. May I know the date on which this claims was processed? Is the provider out of network? Could you please tell me how much was processed towards the deductible? Could you fax / mail me a copy of the EOB?

Claim paid to patient Check if provider is participating Payment details EOB request. May I know when was the claim paid to patient? Can I know how much was paid to the patient? Is the provider participating? Could you fax / mail me a copy of the EOB?