Invoices & Failed Payments
Due to HIPAA, you can not send these documents to a provider on a client's behalf.
Invoices or Superbills
Instead of leaving a thank-you comment that could reopen a closed ticket, agents should do this to show appreciation to the Ops member.
Emoji react to the Ops member's comment.
This is the required action when you need to change a copay back to its original amount, as simply clicking "Save" only records the difference.
"clear overrides & refresh" (followed by re-entering all benefits information)
These calls are made specifically to IAs who handle claims and must always refer to specific past sessions with processed claims data available in Atlas.
Claims Calls
Because Jira is not HIPAA-compliant, you should never put this type of information into a Jira ticket.
Protected Health Information (PHI) or client/provider PHI
This is the reason a valid card is required, even if sessions are fully covered, because things like late cancel fees aren't covered by insurance.
Cancellation Fees (or other charges not covered by insurance, like private pay).
This status is used when a ticket should not have been created in the first place because an SOP exists or the issue is already resolved.
"Ops: Won't Do"
This is the specific Atlas demographic field that is required to be filled out when applying an MO due to the launch of multi-state credentialing.
The patient address field
Claims reprocessing is a payer-driven change done via IA calls, while this is a Headway-driven change done through the Ops Jira ticket system.
Claims Resubmission
If a payment fails due to insufficient funds, Headway will automatically reattempt the charge every 48 hours for a maximum of this many retries.
Two (or a max of 2 retries)
When a client requests a charge be applied to a different saved card, you must first do this to the original charge in Atlas, selecting "Charge Other Payment Method" as the reason.
Refund the Original Charge
This is one of the two distinct pods that makes up the Insurance Ops benefits team, focusing on ensuring patients are eligible for care and understanding their benefits upfront.
Benefits and Eligibility
This is one of the four ways a manually overridden value can be replaced after it's been converted.
AHeadway employee manually changing it, a client/provider/Headway employee removing and re-entering insurance details, a hard refresh to bring back an automatic lookup, or restabilization
What are the 3 required pieces of information required to make a claims call vs a benefits call.
the Claim # (or Payer's claim ID number), total billed amount, and date of service
If a client is contesting a past charge with no claims data (without an EOB), a benefits IA call is allowed because we do not have this information.
Claims Data
This is the temporary amount charged to a client's payment method 72 hours before a scheduled appointment to confirm the card is valid.
$1 charge/hold
This is the action that must be requested via a claims IA call, distinguishing it from resubmission.
Claims Reprocessing
If an MO attempt results in an "Unsuccessful" or "No Lookup" even after troubleshooting, you should submit a Jira ticket to Benefit Ops under this specific issue type.
"Patient eligibility not found"
This is the prerequisite step that must be exhausted before you request any IA call (claims or benefits).
Portal check (or checking the Insurance Portal)
This is the team responsible for managing provider rostering, accurate claim submissions, and resolving claim-related loss.
Claims Operations team
If a refund fails, usually because the original card is closed or expired, the money is returned to us, and we can then issue this instead.
Paper Check
For an Invalid Claim Information request, if you have all the information to fix the error, you should select this issue type instead of "Claim-related LRCS".
Claims Resubmission
In the "Pre-MO steps," using this refresh type removes any existing manual override when refreshing the benefits.
"Clear overrides & refresh"
Clients with new insurance will need to wait this number of consecutive days for a benefit lookup and have the option to proceed with care at a flat fee of $40.
20 consecutive days
When a Manual Override is performed, only the new or updated information is recorded, and this action is created, which replaces the previous one.
New eligibility check