1) First check EOB and find out whether the non covered services is as per the patient plan or as per the provider contract related.
Patient responsibility related:
a) Check in application whether same services previously paid from insurance or not.
b) if paid, then send the claim back for reprocessing.
c) If not paid, then take the action as per the provider specification (Bill patient or write off as per the client specification).
Provider Contract related:
a) Check in application whether previously paid the same services or not.
b) If paid, then send the claim back for reprocessing.
c) If not paid, then check the insurance website to see the policy and find out the services not covered as per the contract.
d) As per the policy if the services not covered as per the provider contract, then write off the charges.
Follow the Below table to ask questions with insurance representatives
| Claim denied as Non covered Service | ||
| 1 | May I know the Claim received date | |
| 2 | May I know the claim was denied | |
| 3 | Check in the application whether we received any patient for the previous dos if yes clarify with ins rep else next question | |
| If Yes | If No | |
| 4 | Provide the information to the rep and send the claim back for reprocess | May I know whether the CPT code is Non Covered or Diagnosis code is Non covered |
| May I know whether it is Patient plan or Provider contract | ||
| 5 | May I know the claim# | |
| 6 | May I know the call ref# |
