self pay
what is the process for payer code 987 hra hnmc
if coins or deductible move money to payer 987
and pointer should match the fin class 2 3
do not flagg you can disposition clm in review.
if full denial posted but it's showing on your list do you work the account?
no, unless is an informational denial you must note the reason for the denial and forward to denial team.
If Janet submitted the medical records for an ER account and your follow up leads to service being denied non covered non emergent do you move the account to self pay
do you reverse the allowance and bill the patient for the entire amount
or do you update to 031 and flag it
031 because the insurance is not covering the bill
unless the eob is already showing our contracting allowance we bill for the contract amount only.
1 do all pip er require medical records
2 do er bill for payer 199 require medical records
3 pip and wc inpatient must go out with medical records and implants if noted
4 if worker's comp payer code 299 and employer is the guarantor example dunking donuts do you send the records what do you do with the bill.
1Yes 2. no 3 Yes and certified 4. No Your can review webhis to see if employer ins is noted if no contact job to confirm if bill needs go a manager supervisor or an worker's comp ins. If no answer send the bill to the patient and ask for direct employer contact or worker's comp insurance
patient call to dispute balance and the account is with agency 17 what do you do
You transfer the patient to the agency
however if patient refuses to speak to agency you must ask why and transfer the call to me.
must introduce call before transfer
What are the refunds that you forward to nikki
negative balances if truly over paid or zero balance that are truly overpaid
negative balance.
if zero balance you wait for the offset
if a patient has united medicare of Minessota what should the payer code be ?
994
IT denials for experimental what do you
You email Lindsey little
true or false
If multiplan is the payer code is this registered correctly
false Multiplan is the network if Multiplan is entered as the ins you must pull the card to verify correct plan and address . must update account to 199
Attorney states he sent release authorization forms but he did not get bill
you must transfer the call to iod
what happens If you hammer to self pay but do not move the pointer to 4
or if you move to self and pointer is 4 but you forgot to remove the hold code
a disposition error is created in your list and Kathy's list .
If missing payment or offset negative balance payment (zero Check )what do you do
you use the status claim under missing payment you must enter the check number and claim #
cob denials- what's the process
We call the patient.
no answer send template letter
If patient answers he is given the claim# and the instructions to call ins and update must get ref#
act under fwrd next step awaiting cob
if no answer we moved to self and we reverse the allowance
True or false credit card payment received insurance ok to process
False We do not accept credit card payment from insurance they must send check. We do not want to pay the fee for processing credit card payment
future patient calls to find out her responsibility on a procedure what do you do
You must transfer to call center 7171
can you have a bi hold code or na on an account that has a payer code 031 from beginning to end explain why
no- because there's no insurance bi and na are only for ins
Are observation bills for payer 170 169 168 all care pd per line or only the er code
most codes are bundle on an observation and the code pd is the er. this is why we delete any compliance codes like labs egk
if the claim is not process after you 2nd call what do you do
You must email the rep your email must include
acc# claim # ID , REf number for call and the reason.
pip er
er code pays 100% xray pay at fee schedule
what do you do
The account is adjusted to 60.60
a wc hold code is entered or
Monica bills the patient for the deductible and follows the steps above
true or false
The attorney calls to find out balance or get a copy of the biller. - biller must verify dob and ok to provide info
false. attorney must be transferred to IOD
why is it important to note deductibles and copay on the eob for Susan's team
This help the collector explain why we are billing the patient the dept frowns at accounts that are not noted or any patient responsibility not noted.
e
What is the big change for behavioral bills for managed Medicaid
these will now be covered by the managed Medicaid plans instead of Medicaid.
We can now bill the hmo's directly
magnacare read physisican only should this be payer code 704
no correct payer is 199
wc new York
if eob does not show the network but the claim pays close to the Aetna drg do we take it or dispute it
you must confirm pd thru Aetna or not eob must show network if no network you must dispute
refund
Account is showing zero balance.
refund received for 3 day rule entire payment is being taken back
do you open the balance to the amount being requested
No You must review if refund is correct If correct note the account refund warranted and close mail
You do not forward it to nikki you close the mail.