Claim not on file Claims mailing address Fax # Whose attention the claim has to be faxed Effective date Timely filing period Verify id and group #. May have the claims mailing address! Could you please give me the fax # and can go ahead and fax it your attention! s patient eligible for the "#$! May have the filing limit for this claim! Claim in process "ate of receipt of the claim %rocessing time. Can have the date on &hich the claim &as received! 'o& long &ould that ta(e to process this claim! Claim forwarded to the payer from the pricin center "ate of for&arding of claim to the payer %ayer phone number. Could you please tell me the date on &hich the claim &as for&arded to the payer! Can (no& the phone number for the payer please! Claim paid Chec( # Chec( date %aid amount )llo&ed amount %atient*s responsibility Write off %ay to address Cashed date Could you please tell me the chec( # and chec( date! 'o& much &as the allo&ed amount for the claim Can you please tell me ho& much &as paid for this "#$! )re there any &rite off on this claim! What &ould be patient+s responsibility! Can you verify the pay to address for me please! Was the chec( cashed! Claim paid to wron address Verify pay to address Telephone appeal to update W, form Cancelled chec( copy if cashed f not- re.uest for stop payment and reissue the chec(. Could you verify the pay to address for me please! Can you go ahead and update your records if give you the correct pay to address for the provider over phone! Could you please give me the fax # and can go ahead and fax W, form to your attention! %lease fax us a copy of the cancelled chec( if the chec( has already been cashed Could you please put a stop payment for this chec( and reissue the chec( to the correct address! Claim denied for !ntimely filin "ate of denial /e0filing and appealing address Verify timely filing limit Fax number. May have the denial date and the filing limit for this claim! Can have the address &here need to appeal for this claim! Could you please give me the fax # and can go ahead and fax it to your attention! Claim denied for elii"ility "ate of denial Effective1 termination date of coverage E#2 re.uest May have the denial date for this claim! May have the effective 1 termination date of patients policy! Could you please fax 1 mail me a copy of the E#2 Claim denied for non co#ered ser#ices "ate of denial "etails of the non covered service Chec( if patient can be billed E#2 re.uest. May have the denial date for this claim! Could you please tell me the services that are not covered under this plan! Can &e go ahead and bill the patient for this claim! Can get a copy of this E#2 faxed 1 mailed to me please! Claim denied for EO$ from the primary ins!rance "ate of denial nformation on primary insurance if the rep has &ith their system Fax number May have the date this claim &as denied! Would you be able to re0process this claim if &ere to fax you the %rimary E#2! Claim denied for co" "ate of denial nformation of the other insurance if they have on their file E#2 re.uest May have the date this claim &as denied! Would you be able to tell me if the patient has any other nsurance! Could you fax 1 mail me a copy of the E#2! Claim denied for capitation "ate of denial f possible date of Capitated contract /e.uest for E#2 May have the date this claim &as denied! May have the date of capitated contract! Could you fax 1 mail me a copy of the E#2! Claim denied for a!thori%ation n!m"er "ate of denial Chec( if there is any auth in the soft&are mentioned for the dos Chec( if they have an auth on file for any hospital claim for the same dos Fax number E#2 re.uest. May have the date this claim &as denied! Could you please tell me if you see any authori3ation # for the same "#$ for the hospital claim! have a authori3ation # in the system- could you re0process the claim if give this number to you no&! Would you be able to re0process this claim if &ere to fax you the claim &ith authori3ation number! Could you fax 1 mail me a copy of the E#2! Claim denied for referral "ate of denial Chec( if there is any referral on the soft&are mentioned for the dos Chec( if provider is participating Fax number E#2 re.uest. May have the date this claim &as denied! have a referral # in the system- could you re0process the claim if give this number to you no&! Would you be able to re0process this claim if &ere to fax you the claim &ith referral number! Could you fax 1 mail me a copy of the E#2! Claim denied as "!ndled& incidental& incl!si#e "ate of denial Ma4or procedure to &hich it has been bundled Can &e appeal &ith medical notes Fax number E#2 re.uest. May have the date this claim &as denied! Could you please tell me to &hich ma4or procedure the claim has been bundled to! Can have the address &here need to appeal for this claim! Could you please give me the fax # and can go ahead and fax it to your attention! Claim denied for referrin physician "ate of denial )s( if provider is the %C% f not as( for %C%+s name and phone number nsurance fax number E#2 re.uest. May have the date this claim &as denied! Would you be able to reprocess this claim if give you the referring physician+s name and 5%6 #! Can have your fax number! Claim denied for incorrect pro#ider "ate of denial Correct provider info Fax number E#2 re.uest. May have the date this claim &as denied! have the correct provider # in the system- could you re0process the claim if give you this information! Can have your fax number please! Claim denied as primary paid ma'im!m "ate of denial )llo&ed amount Verify the primary payment details E#2 re.uest. May have the date this claim &as denied! May (no& the allo&ed amount for this claim! Could you please tell me ho& much did the primary paid on this claim! Could you fax 1 mail me a copy of the E#2! Claim denied for wron dianosis "ate of denial Correct diagnosis code Fax number E#2 re.uest. May have the date this claim &as denied! Could you please tell me &hich is correct diagnosis for this procedure! Can have your fax number please! Could you fax 1 mail me a copy of the E#2! Claim denied for modifier "ate of denial Correct modifier )s( for fax number E#2 re.uest May have the date this claim &as denied! Could you please tell me &hich is correct modifier for this procedure! Can have your fax number please! Could you fax 1 mail me a copy of the E#2! Claim denied for pre(e'istin condition "ate of denial %re0existing condition E#2 re.uest May have the date this claim &as denied! Could you tell me the condition that &as classified as pre0existing for this patient! Could you fax 1 mail me a copy of the E#2! Claim denied as not medically necessary "ate of denial )ppeal &ith medical notes Fax number E#2 re.uest May have the date this claim &as denied! Can go ahead and send the appeal &ith medical notes! Can have your fax number please! Could you fax 1 mail me a copy of the E#2! Claim denied for !ntimely follow !p )ppealing address Verify timely follo& up time Fax number May have the date this claim &as denied! Can go ahead and send the appeal &ith proof of timely follo& up! Could you tell me the follo& up time for this claim! Can have your fax number please! Claim denied as d!plicate "ate of denial %rimary dos to &hich the claim is denied as duplicate )ppeal &ith medical notes Fax number. May have the date this claim &as denied! Can have the details of the primary procedure to &hich claim is duplicated! Can go ahead and send the appeal &ith medical notes! Can have your fax number please! Claim denied as Offset "ate of denial- #ffset dos details- )mount offset- E#2 re.uest May have the date this claim &as denied! Could you give the details of the "#$ offset to! 'o& much &as offset to! Could you fax 1 mail me a copy of the E#2! Claim pendin for additional information "etails of the information re.uired Fax number Could you tell me the information re.uired to process this claim! May have your fax number please! Claim processed towards patient)s ded!cti"le %rocessing date %rovider in or out of net&or( 2rea( up of the benefits E#2 re.uest. May (no& the date on &hich this claims &as processed! s the provider out of net&or(! Could you please tell me ho& much &as processed to&ards the deductible! Could you fax 1 mail me a copy of the E#2! Claim paid to patient Chec( if provider is participating %ayment details E#2 re.uest. May (no& &hen &as the claim paid to patient! Can (no& ho& much &as paid to the patient! s the provider participating! Could you fax 1 mail me a copy of the E#2!