EF 1

General

Content

Step Action
1. Complete steps 1-6 of the About Research Claims procedure.
2.
Provide the allowed amount and advise the provider the claim was paid according to BCN’s fee schedule.
If Then
Agrees

Document and close the SF.

 

Note:

Direct the provider to Availity if they request a copy of the fee schedule.
Disagrees
  1. Obtain the reason why the provider does not agree with the allowed amount.
  2. Advise the provider the inquiry will be forwarded for review.
  3. Route the inquiry as follows:
  • Subject: Applicable Subject
  • Action Requested: Claim Review - Adjustment Request
  • Dept/Team Sending To: CL-SIU
  • Submit to Workflow

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