TIME
Louisiana timely filing
6 months from DOS
states with $25 claims threshold vs commercial
IL, IN, GA.(NH now $5)
Closure reason when there is no overlap between client and other insurance.
Closed no OI
What does the ex code Ai indicate for Mississippi claims?
Cobd Claims
How often should we login to client systems?
Weekly
lookback for Iowa vs Medicare?
130 days from DOS
threshold for new claim notifications to be created?
$1000
two resources we need to use when we need to find an SSN to confirm Medicare in Tier4 Audit Types?
OCM and Idicore.
What should we do to update Fidelis Non-0 Segment lines?
Put in ACT ticket
DISB form we use when we see claim’s we get a check for are in retraction submission status?
DISB form 3
Illinois lag time vs commercial OIs?
7 days from paid date
Timeframe we need to respond to provider calls/voicemails?
within 24 hours
Which state has MercyOne addresses that may prompt scrubbing exceptions?
Iowa
What is the new process we use for claim approvals with client called?
CRP
DISB form when funds were previously recovered and now need to be returned to provider?
DISB FORM 2
How quickly should we complete items on quality report?
24 hours from notification
Write off reason when an incorrect primacy determination was made or not verified?
auditor error primacy
What box do we check in claim image viewer to see if a claim is emergent?
Box 14
What letter do we need to send when we close an invoice for non-CTC states?
Provider Error letter
DISB Form when part of the check needs to be returned to the provider or sent to client?
DISB FORM 1
state with claims that first go provider recovery, then after 6 months, move to Carrier to Carrier?
Iowa
In which state can we not pursue paid claims if it has been more than 60 days since initial invoice date on the investigation OR if it has been more than 60 days since the Amisys COB screen was updated correctly.
Delaware
Which States are the HCSC/BCBS plans where we need to remove the 3 zeroes in our SMART COB screen? (need at least 3 states)
IL, TX, MT, OK, NM
Which states/clients do we need to say Yes or No to P&C and/or BH claims when invoicing?
Florida, Iowa
Where can we go to communicate anything we would like to management?
OfficeVibe