Remark Codes
Remark code(s) when setting up an investigation.
093 998:
What can you review on a UB04 bill to confirm if a room charge is ICU or not?
The toll-free phone number needed on any letter you send.
1-866-855-1212
On the General Case tab, what you review when establishing a claim.
Acc / Illness code is correct.
The letter T in the misc code field indicates what?
When a claim contains information which should be reviewed before processing any new claims.
Remark code when you need R & B charges.
259
If the claim form shows the insured was transported by ambulance, but does not send a bill, what do you do?
Add a 998-note or free-form remark code asking for an ambulance bill.
Notification sent to agent when we receive a claim for a birth, and the baby is not already added to the policy.
212.6
When a final decision is made on a claim, in LHCS, you close out the tasks, remove notes and what else?
(Clue: There are three things left to do)
Reassign the file to the Med Proc queue.
Suppress the claim.
Close the status.
The step before making ANY entry in HICS for a claim?
GLOP check for possible duplicates, previous MCAS and / or reserve entries.
Remark code for diagnosis code(s)
264
If a bill has a statement date of 01/01/26 - 01/05/26, and an admit date of 01/03/26, what would be the From Date on your entry?
01/03/26.
Deny 01/01/26 - 01/02/26 as IN 067.
When records are ordered for a provider after a 900 letter is sent.
Add a note in your Follow Up Investigation task and advise the insured in next 901 letter.
Information you need to notate from Medical Records?
Chief / Principal complaint or current illness or Assessment or Diagnosis.
Actual treatment.
Referring doctors, or referrals to another medical facility or doctor.
The three main things you need to verify on an initial call. (other than PHI information)
Illness or injury and onset date.
Who are their treating providers / specialists/PCP.
Are they unemployed / on SSDI / Medicare and unable to work. READ THE QUESTION DIRECTLY FROM THE APP!
Remark code when you need a bill.
260
If you receive a Claim form and partial bill, the policy is contestable and you are unsure of the diagnosis, should you ask for more information or start an investigation.
Start an investigation.
(You can always close it on receipt of the new information)
The two states that require state specific wording added to letters.
Florida and New Hampshire
When you are reviewing an investigation and preparing to send a 901-letter, how do you update your Follow Up Investigation task?
Add Resultant Activity.
Client Inquiry review needs to note?
Auto, Fire, Life and Health policies.
PNI or NI
No term date
Active status
Remark code when you need a completed claim form.
261
Which three places on a UB04 can you look to confirm an accident?
Box 30 - Accident date.
Box 66 - Diagnosis codes.
Box 72 - External cause of injury.
Letter required when you close an investigation prior to HGC review and pay the claim.
980
You send a Review Policy Provision to your TL and then get new records, what do you do?
Update your referral with the new information.
When do you add a baby to the policy (with a 31-day term) ?
When you receive a bill for the baby.