Adding Coverage, TPL, or WC
Where do you click to add coverage in EPIC?
What is Registration?
We don't handle refunds, but we can do this
What is look at the account and relay if the correspondence has been received
What is the name of our phone system?
Five9
Someone is calling for an appeal. There is no denial on file. What do you advise?
Advise caller that EOB denial has to be received prior to appeal process.
Our records go back as far as...
March 6, 2022
Once you are in registration, where do you click to see patient guarantors or coverage?
What is the patient and guarantor tab?
Where do you find the documents that have been scanned in?
What is the correspondence tab?
What is the status you put yourself in when you are ready to take calls?
Ready
The claim denial is on file and they are asking about an appeal. What do you do in EPIC to assist?
If the denial is on file, and the balance is with the patient, you will send the account (HB) to 252 and (PB) 1147
AHCC stands for what?
Advent Health Centra Care
WC and TPL do not have effective dates. You ask for these instead.
What is Date of injury and claim number
What do we do when they ask for a manager?
use the following script: " I am unable to provide a SUP for you at this time as we are not the refund department. I have reviewed the account and the notes and relayed the information that my department can give. I can notate the account that we spoke today. Is there anything else I can try to assist with today?" If they say anything else argument wise, you can state, "If nothing else, you have a great day." and disconnect.
It's time for a meeting. What status do you change to in five9?
Meeting or Team Meeting
The balance is with insurance in EPIC. They are calling about an appeal. What do you advise?
If the balance is with the insurance, you can let them know that the balance is currently with AR.
When customer service calls, you use this smart phrase.
.CSHELP
IN an HB account once you have added insurance in registration, where do you go to attach the coverage to the account?
Coverages tab
How do we handle bulk refund requests?
If they are calling about bulk refunds, they MUST have them separated by HB and PB for us to process at a minimum. If they say no, " I am sorry but there is not a centralized place for this, and we must have them separated."
The bulk emails/ faxes (requests of 25 or more) get sent to mass refunds and we do not handle these at all. Caller must send it in via fax 423-485-6622 or email(sboinsuranceinq@medsrv.co) and then the mass refunds department will reach out to the caller directly. This process can take 30-90 BD and we are not the bulk refunds department and cannot assist.
Your greeting must include this...
Name
Advent Health Insurance Follow UP department
Recorded line
Closing- like can I have your first name or how can I help today
They are calling in because the visit was supposed to be preventative but is being billed as DX. Where do you go in EPIC to see if the charges are correct or if we need to send to coding?
Doc Notes
What smart phrase do you use if you found the refund on file, but it has not been processed yet?
.INSHBR or .INSPBR
How do you unbill a patient?
What is find the patient balance, click on the box, put your reason for unbilling, and hit enter.
Oscar is calling on behalf of Cigna. They are NOT on file and are wanting to discuss refund information. Can we help them?
What is No, not without an ROI
Walk me through how to transfer a caller
Hit the transfer button
type in the place they need to go
Hit connect
The caller will be placed on hold while you warm transfer the call.
If it is a preventative code, It starts with what letter?
Z
What smart phrase do you use if there is a settlement offer on file that needs to be reviewed?
.PBSETTLEMENT or .HBSETTLEMENT