Basics
How long do you have to TIP a new claim?
Within 24 business hours
What is the common term for the form a medical provider bills on?
Health Insurance Claim Form (HCFA)
True of False? It is mandatory that an insured use their MedPay coverage.
False, MedPay is optional to use
True or False? Attorneys can receive payments for PIP/MedPay rather than medical providers.
True. We can pay an attorney per their request, then the attorney has the duty to pay the provider.
How long do you have to return a voicemail?
Within 24 business hours.
What does KFI stand for?
Key From Image
Who qualifies as a Resident Relative?
Anyone related to the policy holder who lives in the same household.
What 2 documents do attorneys usually request for their file?
Declarations Page and Copy of Policy
True or False? The only person who can access an adjuster's voicemails is the adjuster themselves.
False, you can call the voicemail # and access their messages.
True or False? Every bill must be KFI'd in order to be paid.
False, bills can be paid manually in the event of a lien or demand received.
What template do you fill out when you have a CC to review?
CPW (Coverage Problem Worksheet)
What claim details can we give an attorney before we have received their letter of representation?
No pertinent claim information that gives details on the facts of the claim.
At what point is an activity on your diary considered "overdue"?
10 days
What do you do when you receive a bill on a claim with a pending CC?
Verify the bill and send a letter to the provider.
What is needed in order to process a lost wage claim? (2 documents)
Doctor's disability note and LOW Verification form from insured's employer (or 3 months of prior paystubs if they cannot get the form signed).
Is there a common timeframe that a Letter of Representation needs to be responded by?
No, it depends on the state
What happens if an external email sends you a direct email to your personal work email asking for information?
What is the process of having a medical bill re-evaluated?
Submit an MBR request detailing the provider's appeal under the specified bill (preferably in writing from the provider)
What is the difference between PIP and MedPay?
(Open answer) Medpay is strictly for medical bills, PIP can apply to bills, lost wages, funeral services, loss of services.
What is it called when we do not give the insured their promised coverage?
Breach of Good Faith. (Very Bad)