Claims Policies & Procedures 2025

Effective 4. 2025

OON Plan
Scribe Link for “Non Covered Benefit Process for Claims Workflow” *** This workflow only applies to commercial plan members. If the member has a Medicai...
Mon, 2 Jun, 2025 at 3:55 PM
Member Not Eligible
Scribe Link for “Claims - Member Not Eligible” Apero/Claims Process: Confirm the claim is processed correctly as non eligible (coverage termed)  ...
Mon, 2 Jun, 2025 at 3:55 PM
Non Covered Benefit
Scribe Link for “Non-Covered Benefits Process for Claims Workflow” Apero/Claims Process:  Confirm that the remit code matches non covered benefit or ...
Mon, 2 Jun, 2025 at 3:56 PM
Therapist OON
***Please note: This situation only applies when a Member’s plan is in network with NOCD, but the therapist they were assigned is out of network with their ...
Mon, 2 Jun, 2025 at 3:56 PM
Coordination of Benefits (COB)
Questions to ask yourself in this process:  Did the member upload a different insurance plan? If the member did upload a different insurance plan, is that...
Mon, 2 Jun, 2025 at 3:56 PM
Medicaid/Medicare
Apero/Claims Process: Confirm the member has a Medicaid/Medicare plan (only applies if this is their primary insurance) In Apero, create tasks for you...
Mon, 2 Jun, 2025 at 3:56 PM