Notes

##########SEND BACK###########

01/05/2015


Reference #:823051430910 (3 CLAIMS)
claim paid but went to the provider's write

off// checked cis pro but no allowed amt//

checked cis TOB 131 RM APC// send back

for review// TAT: 30-45 b.days//
CLOSED
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Reference #:151892051311
laim denied for 08I - THE NUMBER OF

SERVICES EXCEEDS THE AMOUNT

AUTHORIZED AND ARE NOT COVERED BY

THE PLAN.//
auth #: 057853139// called CIT to

confirm if auth is valid for DOS//talked

with Ricky and said that auth is VALID

THRU 07/05/2013- 08/04/2014// send

back for review//
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Reference #:182712023912
g0152 is denied for 088// checked gcp on

09/19/2014 but only g0151 is only

showing// send back for review// TAT 30

-45 b.days// pls review thank you//
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Reference #:341864041215 (FOLLOW-

UP)
claim is still pended// provider wants the

claim to be expedited// tat: 7-14 b. days//

logged elig.// timely filing for submitting

appeals is 180 calendar days after the

letter was received by the provider//Attn to

Humana Grievances and Appeals Dept.

P.O. Box 14165 Lexington, KY 40512-

4165.
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Reference #:683636065415
send back for review// prov is disputing

the payment on the claim//
referring claim: 027689390// pls review

thank you..
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Reference #:529334192310
claim was denied duplicate// prov sent an

appeal on 11/26/2014 and we received it

last 10/01/2014// inquiry was closed but

with no determination// TAT: 30-45

b.days//
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01/06/2014

Reference #:978701284609
still in process// follow- up request to

Supervisor//
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Reference #:347468435209
on line 11057 prov disputing the

member's reponsibility there should be

$30 copay// pls review thank you//
Were G and A rights given? No.
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Reference #:304977432712
prov disputing 66984// allowed at 0 and

no exp code//
per cis pro allowed at $939.97// send

back to CRU: pls. reviw thank you.
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Reference #:284612102513 - STOP

PAYMENT
provider wants a stop payment on check

#: 009730151 $9077.03 10/24/2014

still outstanding//

(sent)
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01/07/2014

Reference #:267001310110

claim denief or 08A// send back for

review// primary eob is seen in maces

image on page 2// ps review thank you//

TAT: 30-45 B.DAYS//
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Reference #:994927000810

claim denied for 0SO - OUTPATIENT CLAIM

PAYMENT HAS BEEN ADJUSTED TO

ACCOUNT FOR INPATIENT CHARGES// no

inp claim on file for DOS// send back for

review to cru// thank you//
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Reference #:783214284610
4F - PAYMENT HAS BEEN DENIED BECAUSE

YOUR REQUEST FOR AUTHORIZATION WAS

NOT APPROVED. PLEASE RE-SUBMIT ALL

APPROPRIATE OUTPATIENT CHARGES ON A

SEPARATE BILL.// cit: 800-523-0023//

contacted cit and talked with mary// was

advised that auth 069353249//will send

this back to cru for review// thank you//

TAT: 30-45 b.days//
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Reference #:493471062512
prov was transferred to me from CIT//

prov said that agent confirmed that auth #:

068897728 is valid for this claim and

needs to be processed inn// send back to

cru for revie.w// thank you// tat: 30-45

b.days//
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Reference #:512247211914
02R - YOUR PLAN REQUIRES AN

AUTHORIZATION BEFORE INPATIENT

HOSPITAL ADMISSIONS BENEFITS CAN BE

PAID. THESE SERVICES WERE

PERFORMED WITHOUT THE REQUIRED

AUTHORIZATION, THEREFORE, NO

BENEFITS ARE AVAILABLE. REFER TO

YOUR BENEFIT PLAN DOCUMENT// prov
disputing about the denial for no auth//

referring claim : 031320135// 99307

was paid without auth// send back to cru

for review// thank you//
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Reference #:739129341015
prov disputing about denial fro 33010 and

76930// already filed an appeal but was

denied again// prov wants this claim to be

expedited// send back to code editing

team//
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Reference #:759272022315
corrected calim was received last

11/22/2014 still in process and review//
will do a follow- up with supervisor//

(FOLLOW-UP)
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Reference #:085736005415
claim denied for 0W1 - THIS SERVICE WAS

BILLED WITH AN OBSOLETE PROCEDURE

CODE. THE PROCEDURE CODE DESCRIBES

THE SERVICE PROVIDED. YOUR

PROVIDER HAS BEEN ASKED TO RESUBMIT

A CORRECTED CLAIM// prov disputing

about denial said that previously paid by

humana// referring claim:050218472//

send back fro review to cru// thank you//
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Reference #:118968053816
claim denied for no referral// provider

gave auth #: 069676922// checked cas:

RFN,537349352,1,SIMON,EE,// send

back to cru for review// thank you//


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01/13/2014


Reference #:479462200910
appeal was received on 10/14/2014//

provider wants insystem letter be sent to

them//
insystem #: 196071840// fax #: 217-

525-2543 attn to tracy//
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Reference #:875413283210 (2 claims)
claim is denied for 08A// checked CAS

CRN,587347433,2,BOBBY,EE,// No OI on

file// sending back to CRU for review//

thank you// TAT: 30-45 b.days//
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Reference #:438715550311
99205 is denied for 08I// provider is

disputing about the $271.00 member's

responsibility//provider proivided auth #:

068003487// checked CAS
RFN,308264912,,GERALDINE,EE,//auth is

valid for DOS// sending back to cru to be

reviewed// pls and thank you// tat: 30-45

b.days//
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Reference #:657655042912
provider is disputing about tghe allowed

amount on 78452 which is only .01//

checked cis pro allowed amount is

$452.42// will be spending back for

review to CRU// pls and thank you//
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Reference #:264176521712 (2 claims)
claim denied for no auth//provider

provided auth #: 068867341// checked

cas RFN,436786092,,MICHAEL,EE,, //

auth is valid for claim// will be sending

back for review to CRU// pls and thank

you//
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Reference #:774944081114
provider is disputing about the allowed

amount and per cis pro allowed amount is

$3163.38// will be sending back for

review to be reviewed// pls and thank

you//
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Reference #:444338503714
claim denied for 32 - THIS PROCEDURE

CODE WAS DENIED BECAUSE THE

PROVIDER TYPE/SPECIALTY WAS NOT

VALID FOR THIS SERVICE.// checked

macess image and the rendering provider

is george dehoff III MD// will be sending

this back for review to cru// pls and thank

you//
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Reference #:836370404415
provider is disputing that claim should be

processed as a pcp office visit beacuse dr.

carolyn green is the assistant of the pcp dr.

john woodyear// copay applied should be

$20 only// checked cas

PDN,561936093,D,C,// spec code is 06

and 64// will be sending back to cru for

review// pls and thank you//
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Reference #:888082170116
completed stop payment on

11/12/2014// caller wants for a re-

issuance check adv. to allow 30 business

days pls send the check to this address

p.o box 844809 dallas,texas 75284-

4809
check # 0006979336 check amt $63.92

check date 05/13/2014 claim #

524446039 dos 04/25/2014 charge

amt $567