Provider is Out Of Network denial in Medical billing | PR 242 Denial |

[@ravindrajadhav2379]

Explaination is simply awesome. I had tried to learning AR billing from different video but I have found you videos much informative for me(everyone). Thank you for your videos. Keep making videos.

[@PKRVibesCareerGrowth]

Thank you Ravindra Jadhav.

[@parthasarathyvenkatachari2617]

@@PKRVibesCareerGrowth bro what is credentializing

[@daramallachanakya3869]

Informative video!!! 👍

[@PKRVibesCareerGrowth]

Thank you Chanakya Daramalla !😊

[@KarthikeyanKarthikeyan-e3k]

Sir put vedio details a.r caller

[@dramaworld5918]

Sometimes insurance company will pay when we update pcp details for the denial service is not provided by this network/pcp

[@mohammedyaseen2837]

Awesome 🎉❤

[@SaiRam05032]

Max salary range for AR callers

[@PKRVibesCareerGrowth]

55k for SR associate

[@SaiRam05032]

Thank you so much

[@PKRVibesCareerGrowth]

@@SaiRam05032 Okay. Welcome you 🤝

[@Sonusingh-sh6hd]

Good job sir

[@PKRVibesCareerGrowth]

@@Sonusingh-sh6hd thank you 🤝

[@riteshghosh8229]

Nice one Bro. My suggestion will be make short videos! But nicely explained

[@PKRVibesCareerGrowth]

Thank you. I noted your suggestion.

[@FaizanAmir-jv9bc]

CO 242 Provider is Out of Network / Services not covered by Network / Primary care physician

[@ssd12397]

I have one doubt Patient is in hospice, medicare paid partial amount, for remaining amount if we billed to secondary which is medicaid, denied as patient is in hospice, please clarify this doubt Thank you

[@PKRVibesCareerGrowth]

Good question here. As a Ar caller we need to work on partial denial of Medicare. Also u need to probe why other partial not paid. If ins rep told same, please append GW mod for denied procedure and resubmit claim to Medicare for rest payments. {

[@ssd12397]

@@PKRVibesCareerGrowth Thank u so much

[@Muhammad.irfan90]

Excellent

[@9650330610]

How identify in claim form that provider is in network or out of network?

[@PKRVibesCareerGrowth]

Not possible on Claim form . By calling to an insurance you need to confirm

[@umairhussain1508]

We have that access to check through insurance portals or from all status providers file​@@PKRVibesCareerGrowth

[@sumitdeshmukh9892]

I m looking for this dnl... Thnks for that🙂

[@PKRVibesCareerGrowth]

Most welcome you Sumit 😊

[@Thunderbird786]

Hi sir, I have 1 question here, As i work for out of network provider we billed claim to UHC now payer partially paid for CPT 99281 and rest of the codes such as 96360,96364,96365 and 96361 denied as service not provided by PCP since it was emergency service verified member has POS plan, asked rep to reprocess but rep refused in this case what would be the resolution please answer iam waiting for your answer

[@PKRVibesCareerGrowth]

@@Thunderbird786 yes payer is correct. As per member’s plan (POS) referring doctor(PCP) approval required. So follow your client protocols or as per basic Rcm it is patient responsibility.

[@Thunderbird786]

@@PKRVibesCareerGrowth Thank you so much sir, iam glad that you have answered... I really appreciate that 🙏

[@brilliantmumbai9784]

Nice bro..

[@gilbertchandrakanthkumar6148]

Thanks❤

[@PKRVibesCareerGrowth]

You're welcome 😊

[@Cricketmother]

In secondary insurance patient have ppo plan then primary insurance amount that is transfer to secondary insurance will be added with allowed amount of secondary inssirance plz reply

[@PKRVibesCareerGrowth]

Please I'm not getting here. Please sure if denial is PR 242 and if patient plan is PPO, please note that it is incorrect denial.So you need to probe the same and reprocess the claim s.

[@Cricketmother]

​@@PKRVibesCareerGrowthfor primary insurance patients have hmo plan and for hmo plan patients does not have out of network plan and patients have secondary insurance and patients have ppo plan then we can transfer the amount to secondary insurance , and then primary insurance allowed amount will be added with secondary insurance allowed amount plz reply

[@PKRVibesCareerGrowth]

So primary insurance denied correctly. Kindly check previous Payments history for this doctor and patient on this services. If no previous history found. Please bill the claim to payer which covers patient's PPO plan benefits.

[@Cricketmother]

Thank u sir

[@Cricketmother]

​@@PKRVibesCareerGrowthmy doubt is clear

[@patilnikm8849]

Sir please tell any vacancy for ar analyst

[@PKRVibesCareerGrowth]

Please send your updated resume @ [e-mail]

[@manoonahijanoo9262]

I have doubt that if claim got denied for same out of network provider 242 and PT has EPO plan so will payer cover this service if he has referral ??

[@PKRVibesCareerGrowth]

Only PPO & POS plan will cover OON benefits.

[@FaizanAmir-jv9bc]

🥰@@PKRVibesCareerGrowth

[@ehtehshamshaikh1764]

It will cover if the provider had approved Authorization

[@12345698662]

Hello Sir, very nice video. Can you provide me training?

[@PKRVibesCareerGrowth]

Thank you. For training ping me at [e-mail] (sorry for late response)

[@medicalbillinghouston]

need certified coder

[@arunapeddireddy1149]

Hi sir please do more videos on denials and end action notes

[@PKRVibesCareerGrowth]

Sure Reddy👍