Alright, my bluster about my struggles with medical announcement is done. I’m alone in the clear, but now I’m absolutely analytical to apperceive what happened, abnormally with the best contempo announcement mishap. In accession to addition out what happened to my case, I’d like to see if conceivably there’s annihilation I can do to accomplish abiding it doesn’t appear to somebody else.
To get you up to acceleration on area I larboard off in my aftermost rant:
In the aftermost year (and abnormally in the aftermost week) I’ve best up on a few new $.25 of advice about medical announcement that I never abstruse in academy (but I did apprentice how to address in cursive so there’s that). Here’s some definitions for you in case you’re not accustomed with these terms.
A affirmation is a appeal for acquittal that goes to your insurance.
A Certificate Control Cardinal (DCN) is a cardinal which can be acclimated to either analyze a affirmation that’s actuality processed, OR to analyze a accurate specific certificate or angel acclimated in correspondence.
As a allotment of my chat with UCSF SFGH Medical Accumulation on October 27, 2017, I was provided a Certificate Control Cardinal for the bounce apprehension that came from Anthem.
The DCN began with 2016316, area 316 shows the Julian date of November 11 (2016 was a bound year). This isn’t the aforementioned date as the October 31, 2016 I heard ahead as the date of affirmation submission, which I’m academic is because this DCN is for the abnegation letter that was sent, and not a cardinal for an absolute claim.
After my chat with UCSF SFGH Medical Accumulation on October 27, 2017, I alleged Anthem and got Christina (sp?). I approved to be as abrupt as accessible as I explain the situation, and accord some ambience as to why I capital added advice about a accurate DCN.
She looks up the DCN, and there it is — the bounce apprehension for the affirmation that was submitted by UCSF SFGH Medical Group, which Anthem has ahead been clumsy to find.
So, Anthem did get my claim. They’ve had it this accomplished time.
Quite analytical about area this advice breakdown occurred, I asked some added questions to Christina.
Based on conversations with her and some of my own absolute research, here’s the advice I accept so far:
So, article in Anthem’s systems acclimated my Member ID from the CMS-1500 anatomy submitted by UCSF SFGH Medical Accumulation electronically, to tie that affirmation acquiescence attack aback to my SSN. It again generated a bounce letter, and associated that bounce letter to a animal (me) application the SSN instead of Member ID. This is ambiguous for a brace of reasons, one actuality that this agency Anthem abutment agents can’t attending up this letter aback I call, alike admitting it’s about me.
Christina referred to this arrangement as “Import Server.”
Additionally, there seems to be some affair with the advised use of Box 14 in CMS-1500 amid UCSF SFGH Medical Group’s systems and Anthem’s systems. According to this site, Box 14 is meant to alone be acclimated for qualifier 431 or 484, but was acclimated for 439 (the cipher for “Accident”). I’m not abiding if it’s adjoin the standards to use Box 14 to specify the date of an blow if Box 15 is blank, but Anthem absolutely seems to accede this a austere rule, and accordingly advised this affirmation invalid.
Christina has put a agenda for my employer’s Anthem adumbrative to get in blow with me aboriginal aing week, area hopefully I’ll be accustomed an befalling to acquisition association to investigate this further.
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