QicLink
In HI, in order to see remark code descriptions, you use which key?
%
Remark code used to deny for no response to COB
28
Name 2 QL notes that must be checked before processing any claim
COB and SP notes
What does Malign- mean?
Bad
I am the Director of Operations at Auxiant
Angie Cooling
The system that processes by Batch/Ref number
CEA
Exception code to deny a claim as Duplicate
DU
What does the 07 pull code do?
Pulls the EOB from being sent
What does ocul- mean?
Eye
Who are the two claims supervisors?
Amie and Stacie
I am the system to check claims history
HI
What does exception code, NC, stand for?
Not Covered
What is the general timeframe for PT/OT/ST claims to require a MNR if the group has no visit limit?
8 weeks
What does Gastr- mean?
Stomach
The department that handles claim corrections
EXP/Exception processing
I am the system to make corrections on audits
CA
2Y
Charges after termination date are not covered
What does COB stand for?
Coordination of Benefits
What does Blephar- mean?
Eyelid
No Surprises Act (NSA) claims are repriced by what network?
Clear Health
I am the spreadsheet used to check codes that may be non-covered or require MNR
Quick Reference Guide
Medical necessity review is required
At what percent should CPT, U0003, pay? (Assuming COB is updated and no other issues on the claim)
At 100% (COVID testing)
What does Pulmo- mean?
Lung
What is the remark code to use when prompted "STOP" on a No Surprises Act claim?
qp