ar scenarios with all the points to be verified and asked

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 Check # Check date Paid amount Allowed amount Patient's responsibility Write off Pay to address Cashed date

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?

Claim paid to wrong 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.

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?

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.


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 of capitated contract?


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.


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?


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



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?


Claim denied as bundled/ incidental/ inclusive

Date of denial Major procedure

to which it has been bundled

Can we appeal with medical notes



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.


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.


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 know the allowed amount for this claim?

Could you please tell me how much did the primary pay on this claim?


Claim denied for wrong diagnosis Date of denial Correct diagnosis

code Fax number EOB request.


Could you please tell me which is correct diagnosis for this procedure?



Claim denied for modifier Date of denial Correct modifier Ask for fax

number EOB request.


Could you please tell me which is correct modifier for this procedure?



Claim denied for pre-existing condition

Date of denial Pre-existing

condition EOB request.


Could you tell me the condition that was classified as pre-existing for this patient?


Claim denied as not medically necessary

Date of denial Appeal with

medical notes Fax number EOB request


Can I go ahead and send the appeal with medical notes?



Claim denied for untimely follow up

Appealing address

Verify timely follow up time

Fax number.


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?


Claim denied as duplicate Date of denial Primary dos to

which the claim is denied as duplicate

Appeal with medical notes

Fax number.


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?


Claim denied as Offset Date of denial Offset dos details Amount offset EOB request.


Could you give the details of the DOS offset to?

How much was offset to?


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?


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?


ar scenarios with all the points to be verified and asked

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