Claim Denials EX
7BB
What is patient responsibility?
Which categorization do you use on PD's when money is involved?
What is billing dispute / reimbursement, coinsurance?
When member has dual Delta and MOSA needs to be updated, where does the request go?
What is enrollment?
Where does your rule go?
What is the notes section?
GEAP
What is PEGA?
D01
What is timely filing?
Demonstrates terminology that is understandable
What is resolution letter?
When member has outside coverage and MOSA needs to be updated, where does the request go?
What is claims?
Where does your research go?
What is the analysis screen?
SMCESA
What is Macess?
BD7
What is we are unable to pay for this service as x-rays are needed?
Verify follow up documentation performed & case review/build workflow were followed
What is IRAC method?
Patient is a child and the subscribers and patient have the same last name
What is birthday rule?
Where do you review your claim information/feedback?
What is the effectuation screen?
VMEEATANC
What is Metavance?
ME2
What is you were not covered when this service was done?
Verify all supporting documentation/attachments
What is attaching claims, acknowledgement letters, calls, follow up emails and adding RFI details?
Patient is covered by both a spouse and a parent, which plan is primary?
What is the spouse plan?
What document types CANNOT be attached?
What is Word documents?
RTRENISPEE SNBESSIU TSDPOKE
582
What is your medical plan is primary for this service?
Demonstrates timely case follow up/movement
What is needing to touch the case every 5 business days?
Member has both a Medicare policy and PPO policy, which is primary?
What is PPO?
What details go in the RFI notes section?
What is the RFI template?
MEBREM RETOH SIRBCEUSBR ASAITSIOONC
What is Member Other Subscriber Association (MOSA)?