Life of a Claim Flashcards
What does TAR/Claim Form stand for?
Treatment Authorization Request
What is a TAR/Claim Form for?
Submitted by provider to request:
- Pre-authorization for treatment
- Payment for completed services
What does NOA stand for?
Notice of Authorization
What is a NOA for?
Notifies provider of authorization or denial
What does RTD stand for?
Resubmission Turnaround Document
What is a RTD form for?
Issued when missing or additional information is needed to adjudicate claims, TARs, or NOAs
What is does BeneTARNOT stand for?
Notice of Medi-Cal Dental Action
What is a BeneTARNOT for?
Sent to a member if a requested procedure is modified, denied, deferred, or waiting response from provider
What does CIF stand for?
Claim Inquiry Form
What is CIF for?
- Inquire about the status of a TAR or Claim after 30 days
- Request for re-evaluation of a modified or denied claim or NOA for payment
What does CIR stand for?
Claim Inquiry Response
What does a CIR do?
It sent to a provider as a response to a CIF and only for Claim/TAR Tracer
What does EDI stand for?
Electronic Data Interchange
What is EDI for?
It gives providers the ability to submit TAR/Claim, NOAs, Claim Adjustments, and Claim Status inquires
