Hi, thank you for calling Beta Provider Services.
My name is John.
We don't do you have the pleasure of speaking with?
Hey John, this is Jane.
How are you?
I'm doing great, Jane.
How is your day as well?
Yeah, so far OK.
How about you?
Uh, doing great also, Jane.
Thanks so much for asking and I hope you have a great day as well, OK?
Mhm.
All right, Jane.
So, let's proceed to our concern today.
And how can I help you?
Yes, hi, uh, Eui, uh, I have a question regarding the claim.
Mhm.
Sure.
Mm.
So, you will need clarification or just the status of this claim?
Actually I already know the status, but I want to double check, make sure they I cannot really tell like they pay for the item or not.
Uh, sure.
Yeah mhm.
More than a pleasure, Jane, to assist you with payment details of your claim.
And before the change, I forgot to ask the initial or your last name.
Uh, D.
D.
Thank you so much here.
And let's proceed.
I'll need to verify here the tax ID number of this provider.
OK, XXXX XX XXX.
Mhm.
All right.
And the name of the provider, please?
Jameson Dove.
There we go.
And call book number, please?
You mean the claim number or?
Oh, your callback number.
A call back number sorry 555-555-5555.
Mhm.
All right.
And is this a direct line?
No extension number?
Yes, this is direct line, yes.
All right.
Thank you, Jane, for this information.
Just to make sure we're checking this claim correctly here, is this your first time calling in to check on this claim?
Yes.
All right.
And how many claims are we checking today?
Uh, just, uh, I believe just one, yeah.
All right, sure.
More than a pleasure to assist with this one claim.
And Jane, do you have the claim number?
Yes, I do actually I filed a few times.
OK, the one of the claim number is X000XXX 55555.
Mhm.
Thank you.
And you see the stated multiple claims here.
I will go ahead and just check with the date of service and build them out, OK?
OK.
So, I believe that's January 3, 2025.
And Fill them out here that's $267 is that correct?
Yes, that's correct.
Yes, OK, because, uh, I have one of the items like, uh, OK, the main thing is I want to check 99213.
Do they ever pay me 99213 yeah for yeah.
99213.
All right, sure.
No worries, John.
Yeah thank you.
So, let's proceed just to verify the member's first and last name.
Oh, OK.
The A Jane Doe, uh, April 23rd, 2020.
Thank you.
And the member ID?
The member ID 5555555555.
Thank you.
And I'll just need to verify the rendering provider's name.
Uh, it's Thomas, I think he is.
All right.
And lastly, does the member have any other insurance besides Ambetter?
No.
All right, there is none.
So, let's proceed.
Let me provide a quick reminder to our timely filing for Georgia.
Mhm.
So for initial claims and appeals, for participating providers, that's 180 days, and for non-part, that's 90 days, OK?
OK.
All right.
And upon checking, this claim was received on January 9, 2025 and processed on February 5, 2025.
And uh uh yes, I believe this claim is getting reproceed to a new claim number.
So, let me check and pull up the new claim number, OK?
Mhm OK.
So, I believe you have this claim number ending on 5555.
Let me check because I file I think 3 times.
3 times, I see.
5555.
I do yeah and it got in OK I didn't, I, I tried to tell you what happened.
I filed two lines one is 99213, uh huh that one is like a office visit and the other item is like uh.
Mhm.
94,760, but eventually I got
Mhm.
So at the beginning, I Uh, I think I dispute for 94,760, so I got paid, but and I total bill three times, but I really did see they, they pay me 99213 though.
Mhm.
Oh, I see.
Yeah.
So, let me go ahead and check this, Doe.
OK, OK.
So, the latest claim, I do see here this is the latest one on my system ending on 5555.
Mhm.
Do you recognize that claim number?
Mhm.
Mhm.
All right.
Let me see.
So, for this latest claim here, this was received on February 18, 2025.
And currently, Jane, as of today's day, with this new claim number, it's still pending here.
Mhm.
So currently, we have no information yet for the 99213.
They are still reviewing this for payment.
And if they're gonna approve or deny this, OK?
Oh.
Hold on a second, so which one is the one you talk about, um, can, can you give me a claim number, the last 4?
Yes.
Sure.
So, oh, let me provide you the full claim number, OK?
OK.
All right.
That's X for Xylophone, 000 M for Mango, P for Pear, 555555.
Mhm.
Oh, I have that one already.
Yes.
So, for the claim number, uh, it's currently still pending here.
So we have no results yet since we're checking and also approving or denying the CPD code.
So once since it's gonna be processed within 30 calendar days, that we can go ahead and check if it's denied or not for the 9913, OK?
OK, so when the payment code Y and Z because it from my end I cannot tell what what does it mean Y and Z.
you're right, this one like uh they finally proved the other 1 94,760 but 99213 they in here they didn't say anything they say pending what what does it mean Y Z.
Mhm.
Oh, YZ usually, uh, it's the information of a denial.
So currently, I have no details yet for the claim, but YZ it's a denial.
However, that may differ or may change, uh, within days since they are still reviewing and making adjustment on this claim, OK?
OK, so, OK, OK, got you.
OK, so you want me to call back at a different time or they will OK.
Yes.
So, That's correct.
So, from this year, from, let's go ahead and check the received date, February 18, you need to allow us 30 days or 30 calendar days from February 18.
After that, if we are gonna process your claim accordingly within our policy on the CPD code 55555, the result, I mean, results will show up on your provider portal as well.
But as of today's date, we don't have the details for the 9813.
OK?
OK, and, and, um, you, I, I, I also want to ask you because you know maybe I don't know how to read this.
Mhm.
Can I give you because I have a, I filed 3 times, so let me ask you if let me give you the claim number like uh one of it and to see how you interpret her uh uh Y 028.
Mhm.
Uh, sure.
Mhm.
XX 55555.
OK.
So for your PIN number, uh, you'd like to check the initial denial on this claim?
Uh, So in here when I open it I, I think I must be dispute before so in here they will say 99213 they they say pay 163 22 payment date that you receive.
Mhm.
I don't know, do you see the same thing?
OK.
Uh, currently, um, upon pulling up the claim number ending on 5555, uh, it's currently, uh, being processed to the new claim number.
So, currently, we have no details here, Jane.
Oh, still, OK, because on my end you know I don't understand when I see it, so that's why I'm, that's why you know why I call you because it look like it's showing to me, but is it pay or not pay uh, after adjustment they put something in quote, you know, like a quotation, and the, the next line, there's no quotation with the payment but check number 0 you got they they say pay.
Mhm.
Yes, Mhm.
I see.
Yes, you Mhm.
Oh.
And payment date yeah no they say pay and the payment day but uh um the claim the check number is 0 so that's why many people confuses like I read everything and I get the check number, get everything, and when they on the top they say total check amount 0, but the detail service line they tell you when they pay you check number date amount.
But no payment details.
I see.
Mhm.
Yes.
So do they pay me or not?
I see.
But from your end you, you, you, they did not pay me right?
So,
99213, see.
That's correct.
So, yeah, so let me clarify something here, James.
So, yes, with your claim number X000, currently, I don't see here any payments.
Mhm.
So, yes, I do understand you are confused on this claim since there is or supposed to be payment on this claim, but what we can see here, it's still denied here.
But it's not denied for the reason of other things here.
Right.
It's just denied for the reason of the other claim is getting processed.
DY049.
Since the Y111 is now getting processed for reimbursement or denial here, these old claims that was processed previously or prior to that claim is just getting denied since we are not, or we are avoiding double payments or overpayments.
Mhm.
Mhm.
Uh-huh.
So,
Initially these two claims that you processed here are just denied since we have a new claim number, OK?
Uh-huh.
So for that, all the claims that you pro uh provided us or submitted to us prior to the new claim number are just gonna get disregarded.
So, payment on those, if there is any payment, it will be adjusted to the, to the new claim number, that is Y049.
Mhm.
OK, the last one, right?
The 1 February something.
That's correct.
Exactly.
OK, so right now they haven't paid for 99213.
So, the pendent claim.
That's correct.
OK, OK.
Exactly.
They shouldn't confuse me.
So if they, they, then I would be very concerned to tell you they don't pay me, but they say something they, they, they say pay if you can see my screen then you would, you, you would definitely get why I had to call you.
That's correct.
Mhm.
They say they pay, but the check on the top say no and they also give me a EFT number when they pay me with the number with the amount, but I knew they are not paying me, that's why.
I do.
Mhm.
I just need you to verify they are not paying me even though they tell me they pay me but it's not true.
Yes.
Hm.
OK.
I do apologize for that.
That's quite confusing as well.
No, no, it's not you, it's just I don't know what happened to the assistant.
Yeah, OK, so, uh, can I have a reference number for this call?
Yes, Jane, and before the reference number, uh, do you have like any further questions before we go ahead and proceed?
Uh, no, so the turn around time, uh, will be how long for me to find out.
Yes, on February 18th, that's just 30 calendar days, so.
Mhm mhm so it's like a March, the end of March.
Uh, yes, around, oh, actually, mid-March.
So that should be around March 18, exactly.
OK.
OK, OK, no problem.
All right.
And Jane, before the reference number here, if you'd mind, I'll just provide a quick reminder to our insurance.
Once again, you may also utilize the public website at www.betterhealth.com to check our claims and authorizations.
And also, Jane, if you don't mind, there is also a short survey about my service today.
And would you like me to route you to the survey after this call?
Uh, no, I think I will pass.
No worries, Shane.
I do understand that.
So, for reference number here, are you ready?
Mhm.
OK.
That's I for Indigo 555555555.
Mhm.
Mhm.
Did you get that, Jane?
OK, I got it thank you so much I appreciate it yeah thanks mhm.
All right.
Yeah.
You're very much welcome, Jane.
And I do appreciate your time calling us today, and more than a pleasure to assist you with your claim today.
And thank you for calling Ambetter from Beach State Healthline.
My name is John.
Have a great day ahead and please stay safe.
Bye for now, Jane.
OK thank you mhm bye bye John.