4 | PROVIDERONE BILLING AND RESOURCE GUIDE
QMB – Medicare Only clients ............................................................................................... 74
Claim status .................................................................................................................................. 76
Timeliness ...................................................................................................................................... 77
Adjusting, resubmitting, or voiding a claim .................................................................. 77
Adjusting or Voiding DDE claims ....................................................................................... 80
Resubmitting denied or voided DDE claims .................................................................. 82
Claim templates .......................................................................................................................... 83
Submitting a template claim or batch of template claims ..................................... 86
The remittance advice .................................................................................................................. 89
Understanding claim status .................................................................................................. 89
Retrieving the RA ....................................................................................................................... 89
Adjustment types ....................................................................................................................... 91
Reviewing paid claims ............................................................................................................. 95
Reviewing denied claims ........................................................................................................ 96
Reviewing adjusted claims .................................................................................................... 97
Reviewing in process claims ................................................................................................. 98
Reviewing EOB codes ............................................................................................................... 98
Requesting prior authorization ................................................................................................ 99
The authorization intake process ....................................................................................... 99
DDE prior authorization intake process ........................................................................ 100
General Information for Authorization form, HCA 13-835 ................................... 100
Submitting backup for DDE authorizations ................................................................. 100
Submitting backup for faxed authorizations (no x-rays) ...................................... 101
Checking PA status ................................................................................................................. 101
Additional documentation requests ............................................................................... 102
Cover sheet tips ........................................................................................................................ 103
For more information ............................................................................................................ 103
Appendix A: Verify eligibility with IVR................................................................................ 105
Appendix B: Verify eligibility with magnetic card readers ........................................ 106
Appendix C: Managed care organizations ........................................................................ 107
Appendix D: Casualty and health insurance claims ...................................................... 108
Appendix E: Benefit service packages ................................................................................. 109
ACES program codes .............................................................................................................. 112
Appendix F: Prior authorization process ........................................................................... 118
Appendix G: Authorization status using the IVR ........................................................... 119
Checking authorization status using Interactive Voice Response (IVR) ......... 119
Checking authorization status using ProviderOne ................................................... 120