Benefit Troubleshooting
The first troubleshooting step you should always take when investigating benefit discrepancies in Atlas.
What is a Hard Refresh or Refresh?
The Atlas button you should use to clear any manual override and re-trigger a new benefits lookup.
What is Hard Refresh?
What you should not do if Atlas shows a "Lookup Failure"or "Payer Outage" as this option isn't available for these scenarios.
What is Do NOT attempt a Hard Refresh?
The field in the Claims Dashboard that tells you if the client was overcharged, undercharged, or charged correctly compared to ERA data.
What is Pt_Charge_Status?
The term for the tracking number, sometimes available in Stripe, for a successful refund.
What is the ARN (Acquirer Reference Number)?
What is the amount, in dollars, that requires an agent to flag the request to their TL?
What is $2,000?
The type of insurance plan that often uses a three-letter prefix on the Member ID to determine the correct "home plan" and payer.
What is a Blue Cross Blue Shield (BCBS) plan?
You should submit this type of call only after ruling out a carve-out, input error, or plan mismatch, and after conducting portal checks.
What is an IA Call or an Insurance Call?
The acronym for the document Headway receives from the insurance carrier that provides details on how a claim was processed.
What is ERA (Electronic Remittance Advice)?
The required consent needed from a client before you can refund a session and recharge them on a different payment method.
What is clear, documented consent (or written/documented consent)?
The client must call their insurance carrier to resolve this issue, which puts a freeze on benefits and causes them to appear inactive in Atlas.
What is a Coordination of Benefits (COB) issue or COB flag?
This action must be done before applying a Manual Override, and includes taking screenshots of benefit details.
What is confirming the benefit details in a payer portal or EOB and taking screenshots?
The required confirmation from the payment processor before Headway will issue a paper check for a failed refund.
What is to escalate for a paper check?
The reason for a refund when a client was overcharged because the provider was not $\text{DPSR}$ and the client had already met their deductible. 35
What is the DPSR (Data & Payment Submission Ready) refund (or a similar description of the provider not being ready)?
We refund the client a waived no-show fee via this tool.
What is the Cancellation/Self-Pay Adjustment Tool SOP?
The name of the specialized health benefit that occurs when a client's mental health coverage is managed by a different company than what's on their main insurance card.
What is a Carve-Out?
The only time you should enter "0" in the copay/coinsurance field during a Manual Override.
What is if the client is fully covered and truly owes $0?
This is the specific team you should escalate to when a claim needs resubmitting.
What is Claims Ops?
The type of call you would submit if claims data contradicts an Explanation of Benefits (EOB), and you need to clarify specific session details with the carrier.
What is a Claims Call?
What is the final action that requires a confirmation from Stripe that the refund bounced and funds were returned before it can be cut?
What is a paper check?
The three required fields in the Claims Dashboard that must be $\text{'Submitted'}$ or $\text{'True'}$ and $\text{'High'}$ before you can rely on the data for overrides or refunds. 9
What are Claim Submission Status, Received Processed Claims Data, and Confidence in Claim Accuracy?
The four elements you must include in your "Create Reason" for a Manual Override in Atlas.
What are the Date, CCA Initials, ZD ticket #, and Reason for Override & details?
The key piece of client information you should use to look up the correct "home plan" on the BCBS website.
What is the three-letter prefix on the client's member ID?
The situation that is likely to happen if multiple claims are processed out of sequence by the payer, potentially causing confusion about patient responsibility.
What is the client's deductible may appear unmet even if earlier sessions already met it?
The two parties that must explicitly confirm their consent before you can use the Cancellation/Self-Pay Adjustment Tool to refile private pay sessions to insurance.
Who are the provider and the client?