CRT/Epolicies
T/F. According to e. Policies for trigger CRMOTP, we pay all eligible claims at the INN benefit level.
True
Trigger 6 is pulling on the claim. No Auth has been found but the code is listed on the NPL. Based on this information, what is the correct denial message code for the claim?
deny AV85
This screen shows you the RUMBA version of your claim.
EWM
You are verifying your prov but the names are different. Where can you confirm that you can use that name?
Click prov name, other names
E9ADH4W0K
screen share; cntflat
Trigger BRPRACT is pulling on your INST claim. To resolve this trigger, which provider do you need to add to the claim? Once added, is there anything else you need to do?
Rendering; take it away. NO INST has rendering.
You are working a claim and notice there's a COB trigger. COB tab shows P for other INS. What do you do?
Back out.
What is the status of the provider whose EPDB Pin is 0004839215 for member network 9102 on DOS 09/22/2021?
screen share
Where do you go to see who your RENDERING provider is on EACH claim type?
PROF: lines, INST: none
E8PDJCN5Z
screen share; 201
Trigger 7 is pulling on your claim. To resolve this trigger, which provider do you need to add to the claim?
Supplier
What is the 3 digit rule and how do you see who owns a code?
You can take a CPT on an auth if they have the same first three digits. ECR tells who manages it.
Using the following information, calculate the correct allowed amount for your claim.
CPT Code: 67101
Place of Service: 22
Date of Service: 08/16/2023
Rate System: MCARE2
Member Plan: PPO
Zip Code: 29685
Modifier: 54
Screen share
Line 2 of claim EGTX3SD35 is pulling CNTFCR. Based on the financial comments, how much would the allowed amount be for this line?
98.58
EDFDK6JD9
screen share; OTP
Line 1 of claim EVJM2ZPRK is pulling CRMMROL. Based on the policy for this trigger, what do you do?
Apply Specialist Cost Share
SNF Claims: What do you do if it doesn't come up in the copilot/how long do you wait? What do you do if the claim is INST IP NONPAR.
Hold it (in production) 10 days, still look for auth.
You need to check for SEQ flags; describe what screen you go to, different search methods, and what you are looking for.
EDPBD, TIN/PIN/NPI, SEQALL
What information is under the claim UDT tab?
EPDB Pin
E3JNJDDPW
screen share; top
What does CRT say to do for trigger CNTBAPC?
you do not look up this trigger in CRT.
Why would you need a network ID?
to see if they are par/non.
What screen do you use to look for the pay ind and how do you search for it?
SCM; PBG, select contract, PAY IND
What field do you use to filter by trigger?
Review/Repair reason
E6Y2JJVT0
screen share; cntsnfb add seq