Escalation Case Study

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Cyrilia, Escalation # 2242 is not a true escalation. You sent to escalation because the service form# SFC20150619018078072 had not been completed. However, after viewing the issue the provider is stated that member has Medicare Part A and doesn’t need to send in the EOB. On the contrary, since the member has primary insurance, the provider would need to send in an EOB with states that primary did not pay anything before this claim can be reprocessed. Please put yourself in Project and call the provider back advising this information. Once this has been done, please let me know and I will adjust your time.
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