Eligibility in Millenium
To view and modify information in Millenium, access the "Change Conversation" icon and then choose this option...
What is "Discharge Encounter"?
If we have spoken with the payer and they are denying all or part of the claim and they state that our only option is to appeal, we need to confirm these three things before we begin the appeals process...
What is "ask for the appeals mailing address, what other documents or forms will be needed, and timely Filing guidelines"?
When insurance payers recover funds previously paid to a healthcare provider because they later determine that services were not eligible for payment is called this....
What is "Recoupment"
If a payer's contract updated just prior to the dates of service, this could create a delay with the insurance reflecting the update in their system, causing the short pay. To correct the issue we must do this...
What is "recalculate reimbursement in OHPAC"?
Cash Rep PortalPayment Move Forms are submitted through this portal...
What is the "Cash Rep Portal"?
When adding a new insurance and performing a Plan Code Update, it is vital that you perform this step...
What is "Copy auth data from original insurance"?
This is the level 2 UFC used for a Refund/Recoupment appeal...
What is "RFRC"?
This rule states, if an encompass Health patient is released to home and needs to be readmitted to an acute care hospital within 3 days we must change our claim's discharge status from 01 to 02.
What is the "72 Hour Rule"?
If the contract pays by Per Diem rate and you divide the underpayment by the Per Diem and you get a whole number, it could indicate this...
What is "not all days are covered/authorization issue"?
When receiving a $0.00 EOB via fax, we need to upload it to this Cash Rep portal...
What is "Denials & Quick Remits"?
Upon running eligibility on a newly added insurance, you Observe a "Discrepancies" alert displayed. To automatically correct discrepancies do this...
What is "click the Accept Discrepancies button"?
This "Site" is utilized when we need Shared Services to assist with pulling additional back-up for an appeal...
What is the "Appeals Additional Documents Needed" site?
If an insurance overpays a claim, instead of requesting a refund, they want the overpayed amount to be applied towards the payment of a new claim, it is called this...
What is an "Offset"?
If your patient's stay started in December and ended in January, you should check here to see if the rate updated at the first of the year causing the short pay...
What is "the contract grid tool/contract"?
If we are unable to identify the offset account, we need to take this next step...
What is "Request a Negative Balance Transfer Sheet"?
To change the order of the insurances that a patient has on their account, use this button...
What is "Sequence Insurances"?
For Contract/Agreement appeals, the level 2 UFC used for no payment received is PSI. for a partial payment received, it is this...
What is "CIRU"?
You can use this tool to calculate the difference between discharge to home and discharge to another inpatient facility,,,
What is "the CMS Web Pricer"?
If a Medicare Advantage insurance underpays and the EOB says nothing about Sequestration, enter the paid amount into this tool and see if it matches the underpayment...
What is the "Sequestration Calculator"?
The Adjustment Override function helps to avoid this...
What is "High dollar contractual adjustment requests"?
If the patient advised that they have coverage under a plan that you do not see in Millenium, you should take this next step...
What is "check Cerner to see if any other coverage has been scanned in"?
This form may be required when submitting an appeal for Medicare Advantage plan...
What is the "Waiver of Liability form"?
Insurance companies cannot recoup payment for Coordination of Benefits issues after this time frame...
What is "18 months"?
To confirm CMG contract amount and code, go here in OHPAC...
What is "Click on Expected Reimbursement, then Amount "?
Payment Movement forms CANNOT be used for this...
What are "Manually Posted Payment Errors"?