Insurance Basics
This is the type of insurance you can get starting at age 65, or earlier if you have a qualifying disability or specific medical condition.
This Workqueue list houses the underpay, overpay, and denials WQs.
What is Follow Up?
In Tableau, it can be crucial to click this button before adjusting your search criteria.
What is the pause button?
This board is used to enter new prior authorization grouper requests.
What is the Infinx board?
ESL
What is Exact Sciences Laboratories?
This is the amount of money you must pay out of pocket for a covered service before your insurance plan begins to pay.
What is a Deductible?
This icon can be clicked in a WQ to modify the order of columns and change the order of sorting.
What is the Wrench icon?
This is the resource in SharePoint you can use if you are looking for the workflow steps on completing a billing spreadsheet.
What is the CCA Process Document?
Assignments given to you by Lisa or Megan will initially fall to this group on your personal board.
What is New Tasks?
PG
What is Prevention Genetics?
This is the amount of money you pay an insurance company every month in order to keep your health insurance active, regardless if you go to the doctor or not.
What is a Premium?
What is the Prof TX Inquiry screen?
In BCBS alternate logic claim routing, this piece of information is used to decide which host state the claim will route to.
What is the provider's practice location/address?
This board is used by PFS to request a claims address change.
What is the Systems Ticket Requests board?
HMO
What is a Health Maintenance Organization?
This is an organization that processes claims and handles services for an insurance company.
What is a TPA or Third Party Administrator?
This feature in Epic allows you to look up payor & plan information, contracts & fee schedules, and even PA groupers.
What is Record Viewer?
This document keeps track of the Medicaid rates for all states for CPT 0464U.
What is the PLA Tracker?
This status is set by systems when they have completed your ticket and returned the billing spreadsheet to SharePoint.
What is the 'Ready for Upload Folder' status?
SOMN
What is a Statement of Medical Necessity?
This is the claim adjustment group code that appears on an EOB when the patient is responsible for all or a portion of the claim balance.
What is a PR group code?
This is the corrective action section you can click to perform the Push to Payor activity when needing to send the claim to a different BCBS entity.
What is Charge Correct?
This is the name of the line in the Prof TX Inquiry page in Epic where you can find the Payment ID to look up a remit in FUSE.
What is Reference #?
This is the status we place on an assignment if we have provided a spreadsheet of claims to Market Access for them give to their payor contact.
What is the 'In Progress w/MAM' status?
MRD
What is Molecular Residual Disease?