Member Bill
Member Bill
Member Bill
Member Bill
Member Bill
100
How many days does THPMP have to bill pay a claim?
30
100
Where do you find referrals?
AUTHF
100
When should you go to the member bill workflows?
All Member Bill calls
100
What is POS 11?
Office Visit
100
If a member says they got a bill from Dr Larry’s office what side of PSDSP should you look on first?
P Side
200
What line of a claim will give you more information. P/H or P/U
P/H
200
How many days do most providers have to submit a claim?
60
200
What claim form is an inpatient hospital visit paid on?
UB 04
200
What claim form is an office visit billed on?
CMS 1500
200
What key do you use to open a referral?
F 8
300
What do statuses P/P, C/F and P/F have in common?
All Paid and Finalized
300
What screen(s) show an account number?
OPCLM/INCLM
300
If a member received a bill for $200 because the provider billed THPMP for $400 and they only paid $200 what is this an example of?
Balance Bill
300
What screen(s) shows the total amount of the claim
OPCLM/INCLM
300
What is POS 21?
Inpatient Hospital
400
What is the most common hold reason for referral?
AUREQ
400
If a claim is in the system but you can’t figure out why the member is being billed that specific amount what can you do?
Call provider or Help Desk
400
What does P/F status mean?
Provider's in deficit
400
If a claim paid and it’s less than 3 weeks since post date why might you have to contact the provider?
Balance Bill or Member Paid
400
What do statuses P/F, D/P and P/P have in common?
All Finalized/Posted
500
Other than OPCLM/INCLM how can you tell when the claim was received
Claim Number
500
Is this claim paper or EDI? 000030625HYK
Paper
500
What does Diagnostic testing require
Work Order
500
What is the most common denial reason for a Med Supp claim?
NOPAY
500
What date did we receive this claim? 00003015K3LK
1/15/13
M
e
n
u