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 conclusion
scenario and provide your response specifying whether or not the claim was paid appropriately, and logical steps you took for to arrive at that conclusion. Please 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
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