Are you KEYING me?
What is not always required when keying claims? (1) Notate DCN & Pg Number (2) Check 'Send to Review' box (3) Always put provider as the submitter.
What is Inputting provider as the submitter.
Under what circumstance would we not to key in a member claim.
When charges (total) aren't present on the request.
Send an OBC letter before you have checked these 3 places?
What is MedCompass, HRP and/or RUMBA.
BONUS #1
What workbasket would you send an underpayment to?
What field on a professional claim ensure the member gets paid?
Fields 12 and 13.
If a task has no DCN and a reference number, what kind of claim is it?
Stuck claim, 'EWMP,' claim.
In which of these instances would you create an issue: (1) Valid OPT, (2) Pended DRG Claim, (3) Underpayment dispute.
(3) Underpayment Disputes
BONUS #2
What goes in Box 12, and Box 13 on professional member reimbursement claim?
What boxes auto-populates the provider info on a Institutional and professional claim form?
Institutional: Box 5, Professional: Box 25.
Under what tab can we find other related member ID#'s.
General Tab/Other IDs in HRP
What 4 fields should you check if you get a team mismatch error?
What is Category, ID#, Date of Service and Get Subscriber Info
BONUS #3
Should you still put a rendering provider on the claim if it's not listed and how?
When is it acceptable to exclude the Box 24K, rendering physician ID from a claim?
For services such as DME, Pharmacy, Vision and hearing aid reimbursements.
What is required to route non-par appeals?
Appeal form and intent to appeal
How do you add extra lines in HRP?
CTRL + A
Do I key a member reimbursement if there's no proof of payment, and why?
Yes, the processors will request itemized statement or receipt.
If a institutional claim has 1200 lines, how many claims do we need to key? And where do we send those claims?
2 claim with 600 lines each, routed to the WBI_MDCR_ >99 lines workbasket.
Key an institutional claim on a professional form. What are some ways to differentiate between the two? (1) REV code (2) CPT code (3) Type of Bill
(1) REV code (3) Type of Bill