ACTION ITEM
When you recieve a medicaid lien what action it needed?
Forward to NYPIPMC
What is our goal for DID % to VM?
30%
What is the first day of Autumn known as?
Autumn Equinox.
The number of hours of daylight and darkness is equal.
What if it needs to be issued to a different address?
What are progressive 5 core values?
Integrity, Golden rule, Objectives, Excellence, and Profit!
45 DAY APPEAL
Forward to --"NY45APL"
Re-index & Medical "APPEAL"
What are 3 forms of contact other then calling?
Texting, CC360, email
According to Greek mythology, fall begins when this Goddess returns to Hades causing her mother to allow the crops on earth to die until her daughter is returned in the spring. Who is this Goddess?
Persephone.
When you see "system issued diary"
For example--THE FOLLOWING INFORMATION IS MISSING OR INVALID FOR MDP BILL ########:
PROVIDER TIN
CORRECT THE INVALID TIN IN MDP, REVERSE DECISION TO COMMIT IN MDP AND
RECOMMIT BILL
Where do we forward these?
EFFNY
What are the unit goals for actions items and bills in MCR RVW? WHY?
5 DAYS, 10 DAYS
BE TIMELY MEET REG REQUIREMENTS!
Req for NF10, IME/EUO notices, Copies of IME/Peer medical records, Proof of mailing, Verification and cashed drafts, Dec page
ATTY Document Demand Letter
What is the expectation for working your newly assigned claims, IME reports, and APT reviews??
That day! These are a priority that need to be worked every day!
Which pigment decreases in the plants during autumn?
Chlorophyll.
Who would you need to send a diary to on the claim when we issue an IMEW?
Wage rep! FYI denying wages--Team work!
Per the NYS Reg how many days do we have to address the nf2?
Within 10 business days after receipt of the completed application, the insurer shall forward those prescribed verification forms it will require prior to payment.
What do you do when you recieve a UM/UIM Notice?
1. Is the file owner "active"? If so, review your portion of the letter then forward the Action Item to the F/O
2. Inactive file owner? Diary "YONKERS". Do NOT send action items to YONKERS.
3. Re-label as "Medical / Attorney Correspondence"
4. Tag as "UM/UIM Notice"
What are the steps in completing an appointment verification accurately?
1. contact all providers appliable for that specialty, verify most recent dos, freq and new changes in plan?
2. contact the customer confirm they are aware of the appointment and the importance of attending and that treatment is ongoing
3. if atty repped contact the attorney and verify they did recieve the apt ltr, and that they will have their client comply
4. check mdp for new significant changes, injs? sx? discharged?
Which festival comes from a Celtic autumn tradition?
Halloween
What do you do with a bill that was denied in error and needs to be paid? what are the steps?
1. reconsider the bill
2. remove overrides
3. check MCR approved
4. note in the description box "O/T DENIAL OK TO PAY -MM 9/22
5. Manually save in the reconsideration queue
15 days
What do you do when you recieve records on bill delayed for x303? What are the steps?
1. Review to release bill for payment/denial
2. Enter verification received date on bill in MDP
3. Check "medical records" box
4. Document where in EFF the records are
5. Change "Is Verification Form Needed Box to NO", check MCR approved, Revise/Analyze
6. Re-label as "Medical / Medical Records/Report"
7. Tag with bill #, provider name, dates of service included
What are key principles to providing excellent customer servies?
Responding with urgency!
Showing empathy!
Setting clear expectations on coverage!
Check in and update your customer along the way of the claims process!
What does pumpkin spice contain?
Cinnamon, Nutmeg, cloves, and dry ginger make up the pumpkin spice. It doesn’t contain pumpkin at all.
When you reject an active invoice for payment what are the next steps?
Diary "EFFNY"
Claims pro note with bt# that was rejected, and what action is needed
What steps do we take to address a notice issue?
1. Obtain R/S from EIP why were injuries not reported within 30 days from accident?
2. Contact the cc were they aware?
3. Contact the agent were they aware?
4. Listen to FNOL stmt is this our error? were injuries mentioned?
5. We act fast on this as we have 30 days from report to make a decision!