Identifying and Following-up with Refused or Reduced Claims: A Guide for MOAs

Using the Statement of Assessment and Physicians Resource Guide

1. Using the Statement of Assessment that has been provided, the Physicians Resource Guide and the SOMB Explanatory Codes List, identify the clients with claims that have been refused, reduced or paid out as zero in a Word document.
2. In the same Word document complete the following for each claim that has been refused, reduced or paid out as zero:
Provide the meaning of the Result Codes
Provide the meaning of the Explanatory Codes
List the steps the MOA would need to take in order to follow up with these
claims. What Action Codes need to be used when re-submitting the claims?