Medical Billing RCM on LinkedIn: BCBS Alpha Prefix DAA-DZZ (2024) – BCBS Alpha Prefix List (2024)

Prior Auth approvals of PCSK9 only about 40-45% vs. 75-80% for other branded agents like GLP-1RA or SGLT2. Insurance plans blocking good care. (while making record profits.) I hope the Prior Auth reform rule just approved by the govt will help.

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Friends, its Wealth Wednesday. Here is a nugget:@F&G’s underwriting programs are designed to make the process easy. According to F&G’s internal reporting, most of their clients are underwritten without any invasive medical requirements through their Exam-Free Underwriting Program. #LIAM22 #GetLifeInsurance #LifeInsuranceAwarenessMonth

Medical claims billing can be complex and unclear for members, and when a billing error occurs, members are often lost regarding how to address it.At Unified Group Services, our long-standing partnership with Zelis works to ensure 1.4 million claim edits review for coding errors, unbundling, inappropriate coding, and fraud detection. This ensures accuracy and cost reduction, with a 5-day average claim turnaround. Learn more athttps://lnkd.in/gCJAWm6p#TPA #claimaccuracy

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📢 New Video on WEDI YouTubeEver wondered about real-time prior authorization coverage requirements discovery (CRD) between a payer and provider? Dive into our latest YouTube video where Denny B. (CEO, Massachusetts Health Data Consortium) and Dave Delano (Senior Director of Services, MHDC) share insights on a groundbreaking project!📌 Highlights:-Collaboration with BCBSMA and NEBH.-Introduction of the 'FastPass' Pathways for efficient prior authorization workflows.-Integration of structured X12 278 data & unstructured EHR notes.-A robust system recommendation on authorizations based on extracted data.-Enhancement using FHIR API capability, aligned with DaVinci IGs.🎥 https://lnkd.in/dQvd_rTU

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's underwriting programs are designed to make the process easy. According to F&G’s internal reporting, most of their clients are underwritten without any invasive medical requirements through their Exam-Free Underwriting Program. #LIAM22 #GetLifeInsurance #LifeInsuranceAwarenessMonth#livingbenefits #benefitsfortheliving

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Top 11 reasons for claims denials. #8Modifier misuseCARC 236 Procedure or procedure/modifier combination is not compatible with another procedure or combination provided on the same day.CARC 4 Procedure code is inconsistent with the modifier used.The modifier:1. Should have been appended and wasn't2. Was appended but wasn't required OR3. Was appended to the CPT or HCPCS code but wasn't appropriate due to a coding, billing, or payer guideline.Maintaining appropriate staff for keeping up with coding and modifier guidelines is important. Reduce the number of errors and receive payments on time. Frasier & Harlan can help! Come join the Sunny Side of RCM!

Our medical underwriting directors were once again able to negotiate a significant improvement in an offer for a $10,000,000 survivorship life case.Click on the picture below to see what they did.Are you working on a significant case that might benefit from a second opinion by one of our underwriting directors? Give me a call and let's discuss!#underwritingdirectors #underwritingexceptionshttps://lnkd.in/gKGz2nny

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Our medical underwriting directors were once again able to negotiate a significant improvement in an offer for a $10,000,000 survivorship life case.Click on the picture below to see what they did.Are you working on a significant case that might benefit from a second opinion by one of our underwriting directors?Let's talk!#underwritingdirectors #underwritingexceptionshttps://lnkd.in/gZDeaCfn

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Our medical underwriting directors were once again able to negotiate a significant improvement in an offer for a $10,000,000 survivorship life case.Click on the picture below to see what they did.Are you working on a significant case that might benefit from a second opinion by one of our underwriting directors?Let's talk!#underwritingdirectors#underwritingexceptionshttps://lnkd.in/gZDeaCfn

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🔳 PACS.009 🔳1️⃣ PACS = PAyment Clearing & Settlement + Type .009 = PACS.009 also know as FinancialInstitutionCreditTransfer.2️⃣ It is used to move funds from a debtor account to a creditor, where both debtor and creditor are financial institutions.3️⃣ The FinancialInstitutionCreditTransfer message is sent by a debtor financial institution to a creditor financial institution, directly or through other agents and/or a payment clearing and settlement system.4️⃣ PACS.009 are of 3 types 🔵 pacs.009 Core - Core Financial Institution Credit Transfer (MT 202).🔴 pacs.009 COV - Cover Financial Institution Credit Transfer (MT 202COV) (to cover a pacs.008).🟣 pacs.009 ADV - Core Financial Institution Credit Transfer used to Advise a Cover Payment using the pacs.009 Core (New).#payment #paymentprocessing #paymentsinnovation #paymentgateway #payments

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