Blue2 Messages
The 1st attempt before exhausting this Appeal options.
What is a reconsideration?
The start of the void on Blue2.
What is the latest DF?
The 2nd step after Blue2.
What is NETR?
The route code that's on all HOST Inquiries that are needing to be worked.
What is IH?
The two reason codes used on InfoMsg to send Medical Records to the Home Plan.
What is 173 and 172?
Automatically routed to the appropriate employee based on the SR Inquiry.
What is the KR type Inquiry?
HOST coordinators ask IAs to key the Inquiry number and any pertinent information here on Blue2.
What is Internal comments?
Provider should refile electronically.
What is 95B/95C?
A request used to communicate between Plans.
What is a GENINQ?
The flow to work your Inquiries.
What is the 3R Process?
Forward item via WDMS Peer Review to the assigned coordinator.
What is invalid DF?
Bundling, Patient Information, Contract Number Corrections and Provider Number Corrections.
What is Void Rekey?
To deleted line 1 from the claim.
What is a void rekey?
Is not applicable to HOST and should not be used.
What is the $ Override?
LRM, Plan Profile, XITS and BlueWeb
What are research screens?
Home Plan Request(GENINQ), Claim Adjustment Processing Error, Multiple Contracts and Multiple Claims.
What is when to open a new Inquiry?
Click on Blue2 once you determined the adjustment is not necessary.
What is Mark as Terminated?
Image received with no other correspondence and no related claim or MEDREC.
What is unsolicited records?
Should be document with the new inquiry number, claim number and sccf number.
What is the Parent Inquiry?
The claim has passed through the Local processing edits and shows on our local system.
What is a 199 suspense?
> General Inquiries
> Informational Messages > Claim Misroutes
> Claim Appeals
> Escalations
> Medical Record Requests
What is Blue2
The Inquiry may be routed Monday through Thursday only.
What is Refund Accounting?
Medicare crossover payment information has been provided by the Home Plan
When an image is received from the Home Plan with additional information
A COB determination response is received
A 168 reconsideration receives a response
Any benefit determination regarding processing is received
Home Plan request detailed descriptions not found in the HIPA screen or additional information regarding a service
What is when to send a Letter?
SCCF number, actions taken, claim status and related dates.
What is documentation?
The 1st thing to document in the Inquiry.
What is sccf number?