Appeals
Is HMSA considered Blue Cross Blue Shield Hawaii?
Yes
What would be the correct denial code for invalid Zcode?
CO 16
True or False ? an Escalated worklist is triggered due to a repetitive result of a previous action
TRUE
What is UMRs phone number
877-233-1800
True or False: A Case Manager Attention is triggered when a previous action is performed repeatedly.
FALSE
What does NARA stands for?
No additional records available
What does HMSA stands for?
Hawaii Medical Service Association
What does UMR stands for?
United Medical Resources
What does UHC stands for?
United Health Care
What is the other name of Tricare East?
Humana Military
If the worklist is under appeals follow up, and as per rep on the other line, the subscriber cannot be identified / found, what would be the next appropriate step?
open APSFU cc UR
The Medical records were received but the insurance is requesting for Waiver of Liability, what will be the next step?
open APSFU condition code MRRAA (Medical Records Reviewed as Appeal)
Medical records with NARA not received by the payer, what will be the next step?
complete MRNC calls with CC MRN, then open MRNC with CC Resend
Secondary insurance returns claim due to missing primary EOB , what will be the next step?
open INSFU with cc Missing EOB
Reconsideration is denied due to being not medically necessary, and the patient didn't respond to the consent being requested.
PBN cc AE
💲
What does the dollar sign ($) mean in a case?
Fianancial assistance approved
Next step: Appeal has been received but the insurance has no record of the claim
Resend Appeal CC Resend to New Address (RNA)
Triple S Salud is also known as
BCBS Puerto Rico
📋
What does the clipboard icon with a red check mark mean in a case?
Medical records are on file
👍
What does the thumbs-up icon mean in a case?
Patient consent received
What is the Denial code for invalid place of service
CO - 5
For a patient with a BCBS TN dual plan with no secondary policy, if the appeal has been denied for no Prior Auth, what would be the next step?
Bill the secondary
If a case is in Escalated Calls and has been placed on a 1-day wait for the third time, what is the next step?
keep calling the insurance to obtain updated info
On cases open in INSFU worklist, do we always need to make an outgoing call?
No
If case is open in MRNCLI and MRNC calls, do we still need to follow up?
yes