Take a Guess
Turnaround Time Expectations
Genesys Softphone Statuses
Case Routing
CAS Screen List
100
  • PO Box 14465 Lexington, KY 40512-4465

Medical Records Management

100

Claims Research Unit (CRU) Inquiries

  • 14–30 calendar days
100

Creating Space Development Time

Busy/Offline Work

100

Duplicate EORs for claims not in CRM

Letter reprints

Copy of pricing, pricing sheet, or pricing information

  •  Service Center: Provider
  •  Department: Your department
  •  Topic: Your department
  •  User: Your team lead
100

MHI

  • Retrieves 1 specific claim processed on a member
200

Capitation Definition

Capitation is the method of payment when the provider is given a fixed dollar amount for each patient served. The fixed amount is given regardless of the actual number of patients or nature of services rendered. It is a monthly payment to providers that covers contracted services and is paid before care being provided. This payment method is typically associated with HMO plans. Capitation is expressed as a per member per month amount.

200

Explanation of Remittance (EOR)

Letter

Copy of pricing, pricing sheet, or pricing information

  •  Faxed: 1–5 business days
  •  Mailed: 10–14 business days
200

training to take on new responsibilities.

Training

200

Claim not in system

  • • Service Center: Louisville
  • • Department: Medicare Nonstandard Claims
  • • Topic: Select the appropriate client:
  • - Client 56
  • - Client 57
  • - Client 58
200

CWI

  • Displays special processing instructions, claim specific information, and comments
300

Ways to check Source of Truth 

Go/delegationsotorgo/pcodsot

300

Claim Submission/Timely Filing

12 months from dos

300

Team Meeting: Any team meeting

Coaching: One on One with support leaders

Meeting

300

Payments - virtual credit card (VCC)

  •  Service Center: Provider
  •  Department: Electronic Claims Remits and Payments
  •  Topic: Virtual Credit Card (VCC)
300

CRI

  • Displays coordination of benefits (COB) information of family or individual
400


Authorization/Referral Status 

The provider or facility must match the information the caller gave and the caller must have 1 of the following:

  • Date of service
  • Rendering provider or facility
  • Service provided
400

Urgent (Expedited) Authorizations

within 72 hours

400

You are not on queue and are away from your workstation.

Your workstation is locked.

 Your status displays as Away to other agents.

Away (Idle)

400

Corrected Explanation of Remittance (EOR) when a claim has been adjusted or recouped

  •  Service Center: Provider Payment Integrity
  •  Department: Customer Service Correspondence
  •  Topic: None
400

MAI

  • Displays the accumulation history information for a member or plan by a specific month and year
500

Special Project TAT

  • 90 calendar days from the submission date
500

Correspondence

Medical Records

Dispute

  •  In-network providers: 18 months. If there's an adjustment or recoupment, an additional 6 months are allowed.
  •  Out-of-network providers (Medicare claims): 180 days. If there's an adjustment or recoupment, an extra 3 months are allowed.
500

You are logged in and ready to receive inbound queue calls.

On Queue

500

Stop Payment

  •  Service Center: Provider Payment Integrity
  •  Department: Stop Payment
  •  Topic: Stop Payment
500

RFI

  • Displays referral from PCP
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