View the step-by-step solution to:

Question

I have to summarize this scenario and I need help with words.

Review and research the below

scenario and provide your response specifying whether or not the claim was paid appropriately, and logical steps you took for to arrive at that conclusionPlease provide the resources you used if applicable (i.e. websites, searches, etc.)

·        San Francisco Health Plan (SFHP) received a claim from a participating provider in our network

·        Member on the claim belongs to Brown & Toland Medical Group  (BTMG)

·        The arrangement between SFHP and BTMG is as follows:

o  BTMG is responsible for all professional services

o  SFHP is responsible for all outpatient facility services

o  SFHP has financial responsibility for all injections.

·        Provider is a participating provider

·        Claim is billed on a CMS 1500, with Place of Service 11.

·        Claim has the following billed codes

o  Claim line #1 99213; Claim line #2 90471; Claim line #3 87492; Claim line #4 90739.

·        All claim lines were paid

Recently Asked Questions

Why Join Course Hero?

Course Hero has all the homework and study help you need to succeed! We’ve got course-specific notes, study guides, and practice tests along with expert tutors.

  • -

    Study Documents

    Find the best study resources around, tagged to your specific courses. Share your own to gain free Course Hero access.

    Browse Documents
  • -

    Question & Answers

    Get one-on-one homework help from our expert tutors—available online 24/7. Ask your own questions or browse existing Q&A threads. Satisfaction guaranteed!

    Ask a Question
Let our 24/7 Nursing tutors help you get unstuck! Ask your first question.
A+ icon
Ask Expert Tutors You can ask You can ask You can ask (will expire )
Answers in as fast as 15 minutes
A+ icon
Ask Expert Tutors