CLAIMS
2 Digit code adjustment for services were altered
What is a modifier?
Ask, Acknowledge, and assurance at beginning of call.
What is 3-Part Start?
OPI team is still working on case.
What is Open?
The amount of time a member has to respond to the initial LEP letter
What is 90 Days?
When guiding T1 to cancel an application, RSS should also be cancelling them here.
What is GPS?
Place showing what services are being billed.
What is Service Line?
Member verification
What is HIPAA?
OPI has added a note needing more info.
What is Pending Action?
LEP is based off this percentage of the national base premium set by Medicare.
What is 1% ?
A request to cancel an application before proposed effective date and after enrollment request has been sent to CMS for approval.
What is Cancellation Enrollment?
Status showing payment scheduled to be paid.
What is pending?
Consist of final offer, recap and branding.
What is Closing?
OPI team has completed COB case review and added final notes
What is Pending-Resolution?
Member verbally clarifying that they had drug coverage during a certain period of time.
What is Attestation?
RSS cannot handle calls for these members.
What is C&S DSNP members?
Tab where you will find responsibility of payment..
What is Financial Detail?
Every call should have the 5ws or some kind of notation about call.
What is Documentation?
COB case was fully closed by OPI and RSS teams.
What is Resolved-Completed?
Who receives the money paid from LEP payments?
What is CMS?
A request to withdrawal enrollment before proposed effective date and after enrollment request has been sent to CMS for approval.
What is Withdrawal of Enrollment?
Billed over amount of member responsibility on paid claim.
What is Balance Billing?
Solution to callers issue
What is Resolution?
COB case was withdrawn
What is Resolved-Cancelled?
Who should member be directed to when attestations are after 90 days of initial letter?
What is C2C?
Most cancellations and withdrawal request are routed to this by T1 and do not require assistance.
What is Maestro workbasket?