File Management
This invoice status is used by an ARD Rep to indicate that invoice has been worked.
What is the ADR Collection letter?
This letter series has four letters that must be sent within 30 days of each other and then 30 days after the fourth letter is sent, be sent for retraction.
What is the Aetna federal letter series?
This client is unable to retract no matter what.
Both of these need to be updated every time we move the our invoice forward before we move on to another invoice.
What is the invoice/claim statuses?
This client requests that we follow up and place a recovery note on file within thirty days of the last follow up.
What is Aetna?
You would email this person if you believe a Centene invoice you are working has gone Carrier to Carrier.
What is the PIA?
This letter is sent after we sent the final letter, it has been 60 days since and we are unable to retract for the client GEHA.
What is the GEHA no retract letter? (GEHA NO MD)
In order to retract for this client and state, we must have confirmed that the claim has paid with the OI and there is a credit balance on the account. We also only have 365 days to recover for them.
What is Centene Texas?
All Medicare invoices over $5k need to have one of these two items on the invoice before moving forward to calling the provider.
What is a QO note confirming Medicare is primary or Medicare eligibility call?
All of these invoices need to be worked on the first of the month until completed.
What is an SLA invoice?
You must have this information before you can place a invoice/claim status under direct pending.
What is check #, check date, amount and where it was mailed?
These notices, for our client Cigna, should only be sent by an attorney and can be requested through a TAQ.
What is a Cigna Demand letter?
If we have a provider requested retraction for this client, we need to know when the retraction was requested and who requested it before we can send it over to the retraction team.
What is Emblem?
If I need an invoice reopened to process a check or send an updated request, I would put in a ticket with this department.
What is Product support?
These clients are considered SLA clients.
This note type is used when reaching out by email sent to ATM, TM, TOM, PIA or Legal.
What is the internal escalation note?
These letters are used to help provide additional support on situations (PPS, Medicare timely filing) and different payments methods, and can be located on the K:/ drive.
What are supporting documents?
For Cigna directs, if the PIA is able to see the check but it is not applied to the claim, what needs to be created so we can apply the check?
What is a CO ticket?
In this location would would find the direct spreadsheets, the Kaiser restriction spreadsheets, VA contacts and supporting letters.
What is the K:/ drive?
All new invoices are supposed to be worked within this time frame.
What is 5 days?
This note template should be used for all provider outreach, rather it is a provider outreach note type or a recovery note.
What is the recovery note template?
What is the GEHA_FINAL_ATTORNEY_NOTICE?
For Cigna directs, if the PIA is unable to see the direct, at what date is the invoice added to the lost directs spreadsheet that Khris Romaine reviews?
What is 90 days?
You would search here is if a provider advises that they sent the check directly to Rawlings but we are not showing it received or applied to the account.
This is how many times the PIA should attempt to reach a member for BOC before advising that they cannot reach the member.
What is 3 times?