What's the Plan?
This plan covers New York State Employees
NYSHIP (aka Anthem YLS, C50/G31)
A claim denied as untimely and needs to be adjusted, but the expected amount is $85,365.98
Add to the high dollar adjustment sheet and note the acct
Our expert on WTC, VA, VACCN, Tricare, Humana Military payers?
Shobana
An inpatient claim denied for No Auth, 197
RTDA for a No Auth Appeal
Which cities are hosting the 2026 Winter Olympics?
Milan and Cortina d'Ampesso, Italy. This marks the 1st time 2 cities have officially partnered to host. The ice events are in Milan while the snow events are in Cortina d'Ampesso and other northern Italian locations.
This new plan covers Retired New York City Employees
Emblem NYC Employees Split plan (aka P65). Split between Emblem and UHC
An inpatient claim is denied for invalid coding
Email Stacie C (nicely) for a coding review
Our Expert on Newborn accts?
Emely
An inpatient claim denied as not medically necessary, 50
RTDA for a medical necessity appeal
Which Olympic Skier was severely injured during this year's competition?
Lindsey Vonn sustained a complex tibia fracture when she crashed after 13.4 seconds into her run, Team USA
What is a U02?
Healthfirst Medicaid HMO plan
An outpatient claim is denied for cpt code and rev code cannot be billed together
Send to Rev Integrity for a Coding Review (aka RIRV/coding review request)
Our Expert on Medicare Benefits Exhaust accounts
Jesse
An outpatient claim denies for No Auth, 197
No, after following the process, RIRV to Rev Integ
Who is known as the "Quad God"?
Ilia Malinin, 21, from Team USA, Men's Figure Skating
Which insurance plan now requires a second level dispute prior to escalating to the JOC?
Anthem Medicare Advantage (M55)
A claim is denied as non-covered, 204
Contact the insurance company and verify the denial reason. Is it a covered benefit? Was this denied as non-covered due to No Auth?
Our Expert on Phillips Family Cancer Center
Josseline
An insurance denied based on a readmission
Once it is determined there was a readmission, RTDA
Where will the 2030 Winter Olympics be held?
The 2030 Winter Olympics will be held in the French Alps from February 1-17. This will be the 4th time France has hosted the Winter Games.
Which insurance replaced the Cigna Medicare plan?
Health Spring Insurance
A claim denies for a COB update from the patient
Adjust balance to total charges, send pt letter #138, make 1 attempt to contact pt. After 30 days, if non-compliant, Bill 'Em
Who is the JOC Lead for Cigna, Carelon, Healthfirst, MagnaCare, and Molina?
Nicole Natalie
An insurance company is asking for medical records to review and determine if they agree with the DRG rate billed
No, Follow Up will send the medical records only (MRRH)
What is banned the 2026 Winter Olympic Games?
Backflips in Figure Skating were banned for 50 years but are now legal as of 2024. Double-Touching Stones in Curling. The "Double Touch" Rule was created after Canada's teams were accused of illegally touching the stones after they were released. Ski waxing has been banned to protect the athletes and the environment. Athletes can be banned due to misconduct. Russia/Belarus was banned from competing due to the ongoing Ukraine conflict. Athletes can compete as Individual Neutral Athletes (AIN).