Provider Guide To Understanding Your Report

Your letter includes a narrative explanation of each discrepancy or error code. This narrative explanation provides the factual basis and relevant authority for each discrepancy or error code.

You have been provided with a CD that contains a "Claims List" and may contain a "Service Log". The "Claims List" includes: facility listing of claims reviewed, by recipient, identifying the discrepancy(s) or error(s) for each respective claim. The "Service Log" is supplemental information only for particular provider types, and has specific details for each recipient, for each date of service, that is included in the "Claims List". To understand the detail of the discrepancy(s) or error(s) identified in your "Claims List", please reference each recipient's respective "Service Log".

Each recipient's "Service Log" will identify the services noted during our review, according to your documentation, applicable to the claim dates of service from the facility "Claims List". The services noted on the "Service Log" represent our understanding of all documentation provided by you, to us, during our review for the applicable dates of service. If a discrepancy or error has been identified in a service, it will be so noted in the column with a corresponding code number to the discrepancy or error code number listed on "Claims List".

Link to Prelim Letter Example

Link to Overpayment Letter Example

Link to Claims List Example

Link to Service Log Example


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