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Institutional Claim
Created by alyssajuda
20191204I000024
Instructions:
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What claim form did the provider utilize to submit this?
A. CMS-1500
B. UB-04
C. Medical Claim Form
D. What the office uses
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Why was the member at Park Nicollet Methodist Hospital?
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Use SmartData. What is the address of the facility visited?
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Use help.yourbind.com. What is the copay for Delivery at Park Nicollet Methodist Hospital?
A. $1,500
B. $1,000
C. $100
D. $500
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How much did the facility bill? How much did we pay the provider?
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Look at the notes on this claim. When was this adjusted and why?
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What network priced this claim?
Institutional Claim
(Answer Key)
Created by alyssajuda
20191204I000024
Instructions:
-
What claim form did the provider utilize to submit this?
A. CMS-1500
B. UB-04
C. Medical Claim Form
D. What the office uses
-
Why was the member at Park Nicollet Methodist Hospital?
Maternity Delivery Care
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Use SmartData. What is the address of the facility visited?
6500 Excelsior Blvd St Louis Park, MN 55426
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Use help.yourbind.com. What is the copay for Delivery at Park Nicollet Methodist Hospital?
A. $1,500
B. $1,000
C. $100
D. $500
-
How much did the facility bill? How much did we pay the provider?
$8,972.85 - facility. $5,397.00 - insurance paid
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Look at the notes on this claim. When was this adjusted and why?
Adjusted on 12/4, because it was processed with $1,500 copay instead of $500 smart copay
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What network priced this claim?
United Healthcare