Notes

Caller's Name:yashica
Callback #: 713-781-4600 ext 1206
UMID:H08528186
TAX ID:741700061
Reference #:118813280210

Issue/Concern: Caller is calling about

Claim status.

DOS: 12/04/2013
Charge Amt: $291.02
Claim #:896560075

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim is on fr because of cob

issue//

Were G and A rights given? No.
01
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Caller's Name: barbara
Callback #: 888-492-7742
UMID:H48814512
TAX ID:330057155
Reference #:506230580510

Issue/Concern: Caller is calling about

referral

070445700


Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: referral on file and already

approved//

Were G and A rights given? No.
02
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Caller's Name:tracy
Callback #:217-788-8790 ext 67911
UMID:H58526955
TAX ID:371071858
Reference #:479462200910

Issue/Concern: Caller is calling about

Claim status.


appeal- 10/09/2014
DOS: 03/19/2013
Charge Amt: $9615.00
Claim #: 812053176

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// appeal was received on

10/14/2014// provider wants insystem

letter be sent to them//
insystem #: 196071840// fax #: 217-

525-2543 attn to tracy//

Were G and A rights given? No.
03
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Caller's Name:brandy
Callback #:734-458-4659
UMID:H49132827
TAX ID:381358390
Reference #:153046021710

Issue/Concern: Caller is calling about

Claim status.

DOS: 12/18/2012
Charge Amt: $27078.07
Claim #: 783666565
corrected claim- 09/16/2014
950042678- $26238.07
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim summary fax to 734-422-

0273 attn brandy//

Were G and A rights given? No.
04
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Caller's Name:martha
Callback #:601-249-5510
UMID:h59829929
TAX ID:640468873
Reference #:875413283210

Issue/Concern: Caller is calling about

Claim status.

DOS: 10/16/2014
Charge Amt: $134.00
Claim #:038514748

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// 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//

Were G and A rights given? No.
05
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Caller's Name:martha
Callback #:601-249-5510
UMID:h59829929
TAX ID:640468873
Reference #:875413283210


Issue/Concern: Caller is calling about

Claim status.

DOS: 10/16/2014
Charge Amt: $141.63
Claim #:038490857

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//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//

Were G and A rights given? No.
06
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Caller's Name:trisha
Callback #:276-783-5157
UMID:H44330104
TAX ID:541891004
Reference #:880059453810

Issue/Concern: Caller is calling about

Claim status.

DOS: 12/13/2013
Charge Amt: $283.00
Claim #:023387720

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//claim denied for 08B// checked

cas : CRN,223966660,3,GLENNA,EE, //

Were G and A rights given? No.
07
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Caller's Name:GALE
Callback #:501-627-1860
UMID:H5065039400
TAX ID:621684203
Reference #:088301274110

Issue/Concern: Caller is calling about

Claim status.

DOS: 10/06/2014
Charge Amt: $418.00
Claim #:021850414


Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// provider is disputing about line

item: 99215// referring claim #:

020361269

Were G and A rights given? No.
08
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Caller's Name:GALE
Callback #:501-627-1860
UMID: h09397567
TAX ID:621684203
Reference #:088301274110

Issue/Concern: Caller is calling about

Claim status.

DOS: 05/21/2014
Charge Amt: $236.00
Claim #:964070102

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//83036 was denied for 11G - THE

TOTAL UNITS BILLED FOR THIS PROCEDURE

BY THE SAME OR A DIFFERENT PROVIDER

EXCEEDS THE MAXIMUM ALLOWED FOR

THIS DATE SERVICE.

Were G and A rights given? No.
09
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Caller's Name:GALE
Callback #:501-627-1860
UMID: h42624889
TAX ID:621684203
Reference #:088301274110

Issue/Concern: Caller is calling about

Claim status.

DOS: 01/23/2014
Charge Amt: $95.00
Claim #:913796409

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//08I - THE NUMBER OF SERVICES

EXCEEDS THE AMOUNT AUTHORIZED AND

ARE NOT COVERED BY THE PLAN. REFER

TO YOURBENEFIT PLAN DOCUMENT.

Were G and A rights given? No.
10
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Caller's Name:GALE
Callback #:501-627-1860
UMID: h51475484
TAX ID:621684203
Reference #:088301274110

Issue/Concern: Caller is calling about

Claim status.

DOS: 12/15/2014
Charge Amt: $46.00
Claim #:053320931

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim denied for no referral//

Were G and A rights given? No.
11
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Caller's Name:pat
Callback #:317-387-7652
UMID:H51384356
TAX ID:352108729
Reference #:438715550311

Issue/Concern: Caller is calling about

Claim status.

DOS: 09/11/2014
Charge Amt: $331.00
Claim #:010948573

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// 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//

Were G and A rights given? No.
12
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Caller's Name:MARK
Callback #: 362-343-2915
UMID: 006775089
TAX ID:270957116
Reference #:196663191311

Issue/Concern: Caller is calling about

Claim status.

DOS: 12/23/2013
Charge Amt: $576.00
Claim #:201401166833876

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim was reprocessed on

12/30/2014// gave PPID: 1 (800) 438-

7885//

Were G and A rights given? No.
13
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Caller's Name:christine
Callback #:877-772-2001 ext 297535
UMID:h46739475
TAX ID:113358535
Reference #:526870432911

Issue/Concern: Caller is calling about

Claim status.

DOS: 04/15/2012
Charge Amt: $22185.00
Claim #:726405740
appeal- 09/25/2014
ref #: 540870512511
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim is on FR//transfer to PPID: 1

(800) 438-7885//

Were G and A rights given? No.
14
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Caller's Name:anna
Callback #: 610-550-2885
UMID:h44644075
TAX ID:581897274
Reference #:568370164611

Issue/Concern: Caller is calling about

Claim status.

DOS: 11/05/2013
Charge Amt: $8204.51
Claim #:888530937
appeal- 09/09/2014
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// appeal received last 09/15/2014
and still in process//
Were G and A rights given? No.
15
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Caller's Name:anna
Callback #: 610-550-2885
UMID: h51518132
TAX ID:581897274
Reference #:568370164611

Issue/Concern: Caller is calling about

Claim status.

DOS: 05/11/2014
Charge Amt: $8823.77
Claim #:958130261
appeal- 09/12/2014
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//appeal received last 09/16/2014
fr was maintained//
Were G and A rights given? No.
16
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Caller's Name:debbie
Callback #:864-987-0034
UMID:H56908113
TAX ID:175038321
Reference #:386761441712

Issue/Concern: Caller is calling about

Claim status.

DOS: 10/13/2014
Charge Amt: $359.00
Claim #:021804208

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//

Were G and A rights given? No.
17
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Caller's Name:sheryl
Callback #:412-442-9607
UMID:h59698800
TAX ID:271440673
Reference #:738884172512

Issue/Concern: Caller is calling about

check info//

check #: 009654782 10/18/2014-
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: check info given//

Were G and A rights given? No.
18
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Caller's Name:sarah
Callback #:919-544-6318
UMID:H59337966
TAX ID:562239644
Reference #:657655042912

Issue/Concern: Caller is calling about

Claim status.

DOS: 08/18/2014
Charge Amt: $3060.00
Claim #:002416938

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// 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//

Were G and A rights given? No.
19
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Caller's Name:joane
Callback #:253-428-8700 ext 3726
UMID:h58959349
TAX ID:911867315
Reference #:708691483512

Issue/Concern: Caller is calling about

benefit.

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: $40 copay for specialist

ov// logged elig//
Were G and A rights given? No.
20
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Caller's Name:nikki
Callback #:225-924-0444
UMID:h59459369
TAX ID:000085787
Reference #:264176521712
Issue/Concern: Caller is calling about

Claim status.

DOS: 11/18/2014
Charge Amt: $2300.00
Claim #:039502174

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken:claim logged// claim info

given// 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//
Were G and A rights given? No.
21
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Caller's Name:nikki
Callback #:225-924-0444
UMID: h45153351
TAX ID:000085787
Reference #:264176521712

Issue/Concern: Caller is calling about

Claim status.

DOS: 11/05/2014
Charge Amt: $7500.00
Claim #:033808654

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim denied for 04@ and 0)9.//
provider provided auth #:068581214//

checked CAS

RFN,994061180,,KELCIE,EE,,// auth is

valid for claim// will be sending back for

review to CRU// pls and thank you//
Were G and A rights given? No.
22
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Caller's Name:heidi
Callback #:502-588-0583
UMID:01273203602
TAX ID:000057136F
Reference #:054102525912

Issue/Concern: Caller is calling about

Claim status.

DOS: 02/05/2014
Charge Amt: $5200.00
Claim #:201402106074441


Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// provider is disputing about the

66183 all payment went to member's

repsonsibility// provider gave ref #:

cdr062604069

Were G and A rights given? No.
23


############################

Caller's Name:jessica
Callback #:727-726-0120
UMID:h45452037
TAX ID:593224557


Issue/Concern: Caller is calling about

Claim status.

DOS: 07/29/2014
Charge Amt: $125.00


Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: transfer to HumanaOne:

800-833-6917

Were G and A rights given? No.
24
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Caller's Name:jessica
Callback #: 830-672-9508
UMID:H56684451
TAX ID:741625013
Reference #:587729325013

Issue/Concern: Caller is calling about

Claim status.

DOS: 10/01/2014
Charge Amt: $4998.00
Claim #:141056795

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//

Were G and A rights given? No.
25
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Caller's Name:ada
Callback #:410-933-2796
UMID:H45045840
TAX ID:522218584
Reference #:785979235813

Issue/Concern: Caller is calling about

Claim status.

DOS: 11/19/2014
Charge Amt: $2048.04
Claim #:059234166

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//

Were G and A rights given? No.
26
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Caller's Name:alta
Callback #: 269-276-4911
UMID:h49101153
TAX ID:382511179
Reference #:841911270214

Issue/Concern: Caller is calling about

Claim status.

DOS: 06/13/2014
Charge Amt: $332.00
Claim #:533090788

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// provider disconnected the call//

Were G and A rights given? No.
27
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Caller's Name:sheila
Callback #:913-814-2098
UMID:H51233200
TAX ID:621807084
Reference #:774944081114

Issue/Concern: Caller is calling about

Claim status.

DOS: 01/03/2014
Charge Amt: $3165.01
Claim #:012891686
ref #: 162283510317
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// 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//

Were G and A rights given? No.
28
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Caller's Name:susan
Callback #:828-315-4616
UMID:h40071102
TAX ID:561281967
Reference #:387125562314

Issue/Concern: Caller is calling about

eligibility.

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: logged elig//35%

coinsurance//logged moop//

Were G and A rights given? No.
29
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Caller's Name:anne
Callback #:978-367-5000 ext 104
UMID:h49550639
TAX ID:042675303
Reference #:182933352714

Issue/Concern: Caller is calling about

Claim status.

DOS: 11/01/2014
Charge Amt: $422.47
Claim #:035363395

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// prov wants re- issue of check

because check #: 000103489 is still

outstanding last 11/16/2014//

Were G and A rights given? No.
30
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Caller's Name:kiana
Callback #:305-731-7196
UMID:H11326344
TAX ID:630649108
Reference #:444338503714

Issue/Concern: Caller is calling about

Claim status.

DOS: 07/29/2014
Charge Amt: $65.00
Claim #:991196136

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//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//

Were G and A rights given? No.
31
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Caller's Name:kiana
Callback #:305-731-7196
UMID: h59544895
TAX ID:630649108
Reference #:444338503714

Issue/Concern: Caller is calling about

Claim status.

DOS: 08/05/2014
Charge Amt: $297.00
Claim #:994959963
corrected claim- 12/02/2014

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//cc received last 12/10/2014 and

still in process//

Were G and A rights given? No.
32
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Caller's Name:barbara
Callback #:212-337-5746
UMID:H43283537
TAX ID:132911059
Reference #:437938480515

Issue/Concern: Caller is calling about

Claim status.

DOS: 08/01/2014 - 08/31/2014
Charge Amt: $28139.32
Claim #:046353797

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// claim is denied//

Were G and A rights given? No.
33
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Caller's Name:carmen
Callback #:843-792-0789
UMID:H44607989
TAX ID:570935917
Reference #:023573362715

Issue/Concern: Caller is calling about

Claim status.

DOS: 09/08/2014
Charge Amt: $1611.00
Claim #:012063917

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//

Were G and A rights given? No.
34
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Caller's Name:carmen
Callback #:843-792-0789
UMID: h59670225
TAX ID: 1417384462
Reference #:023573362715

Issue/Concern: Caller is calling about

Claim status.


Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: transfer to MGP: -800-944

-9442

Were G and A rights given? No.
35
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Caller's Name:paula
Callback #:910-576-0042
UMID:H40764371
TAX ID:561936093
Reference #:836370404415

Issue/Concern: Caller is calling about

Claim status.

DOS: 10/08/2014
Charge Amt: $175.00
Claim #:020516930

Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given// 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//

Were G and A rights given? No.
36
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Caller's Name:marleen
Callback #:888-861-2283
UMID:H55733108
TAX ID:760385534
Reference #:888082170116

Issue/Concern: Caller is calling about

Claim status.

DOS: 04/25/2014
Charge Amt: $180.00
Claim #:534036722
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//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

Were G and A rights given? No.
37
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Caller's Name:tori
Callback #:601-267-7777
UMID:h54096809
TAX ID:640840130
Reference #:669786031516

Issue/Concern: Caller is calling about

Claim status.

DOS: 08/20/2014
Charge Amt: $270.00
Claim #:998372958
ref #: 249938114814
Expected Outcome:To provide accurate

information.

Systems used: GCP

Actions Taken: claim logged// claim info

given//


Were G and A rights given? No.
38