Validation
Which is the correct code for a validated timely filing?
XY
Where do we download and upload the letters?
Appeal Assistant
Which disposition do we use when we finish the account?
OSENT
Which root cause can we use for a COB issue?
TFOII
Where do we remove the denial code?
Artiva
What is the first activity we need to submit in Concuity?
Validated denial
Which activity do we upload to Concuity when we write the letter?
Technical appeal written activity.
What is the order of priority we use for uploading appeals?
1. EDDS portal and Availity.
2. Fax
3. EDDS mail
Which root cause is appropriate when we have the same payer billed multiple times because there were errors in billing?
TFCCB
Which is another form of calling the remove denial code?
Make the account inactive.
What is the minimum and maximum amount we can work in appeals?
Minimum: $250.
Maximum: $100,000.
How many options of letter do we have? Which are they?
5 letters.
1 for not a clean claim, 1 for billed timely, 1 for billed untimely, 1 for COB issues and 1 for uncooperative patient.
Which activity do we upload to Concuity when we sent the package? (2 options)
Appeal Uploaded for EDDS Portal, Availity and fax.
Appeal mailed for EDDS mail.
Which root cause is more appropriate when the payer denied for timely filing in error? The claim was billed timely.
TFNCI
What are some cases in which we remove the denial code?
When the primary paid more than secondary, when the primary have not paid in full, when the timely filing was caused by underpayments, when there is not enough info to validate...
Which disposition should we use to finish the validation part?
OITR
What is the main purpose of the extenuating circumstances we write?
To show the payer what happened, in a chronological order, that led to the timely filing in the account. To show the history of the account.
Which follow up date should we put in the Appeal Uploaded/Appeal mailed activity?
If appeal amount<5K: 60 days.
If appeal amount>5k but <10K: 45 days.
If appeal amount>10K: 21 days.
Which root cause is more appropriate when we have delay in collections? eRequests, coding issues, iplan sequence errors...
TFDCA
Which status and reason should we use when we remove the denial code?
Status: Status refresh needed.
Reason: Blank
What is the Status and Reason we need to use when validating?
Status: Status refresh needed.
Reason: Denial Validated.
What are some aspects we include in the extenuating circumstances?
Dates of service, what the patient registered at the admit, if there was a COB issue, not a clean claim, a denial in error, etc...
What are some of the documents we can include in the final package?
Facesheet, remits, UB04, itemized bills, payer forms...
Which root cause is more appropriate when the patient registered with no insurance or uninsured and the insurance was discovered later which cause the TF?
TFRBA
Which are 4 things we need to put in the appeal shell when closing because we removed the code?
Code: 99
Disposition: IINND
Appeal amount: $0.00
Close date: The date you are working.