Tools
The tool that stores cases and clinical outcomes for both professional and facility claims.
PICTS
What is the "intentional misrepresentation to gain a benefit"?
Fraud
How many teams are there in PIRT OGA?
3 - 2 teams in Manila and 1 team in Bangalore, India
FALSE
This describes services whether it is medical, surgical or diagnostic and is designed to communicate uniform information about medical services among physicians, coders and insurances for administrative, financial and analytical purposes.
CPTs
Loads image numbers for documents submitted via mail and fax.
Doc360
What word is defined as "Mistakes or inaccuracies that can be fixed easily?"
ERROR
Who is PIRT's DM?
Paul Lumang
How many days is the standard TAT for a review to be completed?
15-45 days
In general, what service was performed if the first digit of the CPT is "0"?
Anesthesia
Used to provide definition or description of CPT codes, HCPC codes, ICD10 codes, modifiers and revenue codes.
Knowledge Library
____________ is defined as unsound business practices that result to an overage in payment.
ABUSE
How many SMEs are there in PIRT?
2
This tool keeps the schedule of the agents - lets them know when to take breaks, lunches and their phone times. Also used to plot schedule exemptions within the day.
IEX
Also known as alpha-numeric codes since it contains a single alphabetical letter followed by 4 numeric digits.
HCPCS Codes
Search engine for job aids of PIRT.
Knowledge Now
What is the unneccesary use of health care resources?
WASTE
What is the name of the AM that is supporting reps handling non-UHC Commercial accounts?
Gay Calangi
What are the 2 ways to submit a claim?
By paper or electronically.
What medical records are needed if the service billed is a "complete blood count" (CBC)
physician's order and lab results
Stores denial letters for initial review.
DocDNA
Types of claims that are reviewed by the Special Investigations Unit (SIU).
FRAUD claims.
Who is our top PIRT agent for 2023?
Ronalyn Espineda
How can providers submit medical records?
Mail, fax, online portal
In general, what is the best answer if callers ask us what kind of records to submit?
“We need to have records pertaining to the codes that were billed on the claim.”