Page 29 - Claims Handbook

Non- Participating Providers (Status OA or NP)

Non-Par Medicare Number Needed (322) - Amisys #0010 - EX code = p1
Non-Par Medicare Not in System (324) - Amisys #0009 - EX code = p3
Non-Par Member Region Doesn’t Match (323) - Amisys #0008 - EX code = p2
Non-Par Additional Tax ID# Needed (321) - Amisys #0007 - EX code = p0
Non-Par Address Doesn’t Match (320) - Amisys #0006 - EX code = 98

Review Area Field - EX code = BU (manual pend)

 Verify that “Pay Class” does not read “DUMMY”.
 If it reads “DUMMY” but the Carrier and Region match the member’s Carrier and
Region, then it is OK.
 If it reads “DUMMY” and Carrier and Region do not match, space out affiliation and
readjudicate.
ï‚· Verify the correct affiliation has been generated.
 If that does not work, enter the member’s PCP number and affiliation in the Referring
Provider fields.

 Verify address by clicking “Aff Address” in the left-hand pane.
 If the servicing provider’s address and Amisys do not match, review the Provider’s
Remarks in Amisys.
 Copy the Provider # from adjudication screen.
 Click on “Remarks” and a new screen will pop up.
 Click on the binoculars/find icon on the top tool bar.
 Click on the “ID# Type” drop down menu.
 Select “PV.”
 Place cursor in “Provider#:” field and paste Provider #.
 Hit Enter and the remarks will display.
 Hit the “Next” button in the top tool bar to scroll through.
ï‚· If the remarks state to pay to a different address than what is stated on
the readjudication screen and it is also on the affiliation screen, it is OK
to pay.
ï‚· If the remarks do not match the information on the provider claim, pend
the claim with the Provider Relations pend code for “address doesn’t
match” from the list above.

 Confirm claim address and Amisys address are correct.
 Exit out of address pop-up window.
 Click binoculars/find icon on the top tool bar to clear fields.

 Select “Diagnosis, Procedures & Service Detail” tab on the readjudication screen.

 Check that the Status “St” has ALL 10s, 11s, 12s, 50s, 51s, or a combination of 10s, 11s, 12s, 50s, and
51s.
ï‚· If the status contains ANY other codes, DO NOT demand draw. The claim will fall into an
appropriate queue to be fixed.
ï‚· Do not Demand Draw 31 or 41 status.
ï‚· If there are other EX Codes remaining and you are able to process them, continue to process
them.
ï‚· It is OK if there are other Ex codes besides AP or CP if you do not know how to process them.

ï‚· Demand Draw the claim from the queue.
 Maximize Macess.
 Select “My Work” from tool bar.
 Select “Workflow Examination” on the drop down menu.
 Click the “Draw Mode - Demand” icon.
 Click the “Select Work Item” icon.

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