Week 6

What is the timely filing for an out of network claim to be submitted?

180 days from the date of service

we do not take out of network claims

December 31 of the following year

120 days for the date of service

Which bluelink would you use when a provider advises the immunization billed should have allow multiple administration fees and you want need to verify the number allowable?

1. Professional provider lookup New York

FKB FKF modifiers 51 59 76 91 and 99

Injection and Vaccines

CXT Appeals

The Provider says the service is not bundled. The override field just has an E611 and the place of service is 23. What BLUELINK doc Steps will determine if the service is bundled?

1. Professional Provider Look Up New York

2. ClaimsXten CXT – Claim Lab

3. NYHCRA Price Bundle – NY

4. All of the above

What dental plan do we automatically cross over too when the dental date of service is final?

Aetna

Delta Dental

FEP Blue Dental

All of the above

If a provider submits a claim as an individual provider but the pin starts with a W and it is not a specialty that is shown as and exception in the Professional Provider Look Up -New York BL. Can you code the individual provider to this pin?

Yes, because the providers name is showing as the group

No, because the pin is a group pin not individual

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