ATS
True or False: It's encouraged to keep at least 2 sessions of ATS open at all times, one to enter your case and one to conduct research in.
You better be saying False
What does CAP stand for?
Claim Audit Platform
Name the policy that is routed to 100 ADJ ADJ for reconsideration.
Railroad Groups (00001; 690100; 46000; 23111; 107300)
When do the "Recon Required?" and "Recon Completed?" fields become available? and where?
After check rules, and in the Create Case Triage header section
What's Macho's full legal name?
Macho Cat Randy Savage
Once you identify you received an ORS indicating that an item was sent to Single Adjust in error, what should be done?
Place on the SME SharePoint for review and direction.
Is the HR remark code considered FWAE?
No, remark Codes HR, IQ, KC, and OO are not considered FWAE per our SOP
What is an updated routing address for Optum Waste & Error reconsideration?
550 FRD AFR
Where can we look to confirm if reconsideration completed or not?
ORS, purged ORS, PIQ number, PICTS case ID, Letter Generation ID or ETS/ATS Case ID
What grade is Henal in?
2nd Grade!
The Case Type we would select Standard Time Frame in Drug Line Level Details.
What is an Alternate Appeal Type?
True or False, When a subsequent review is required for Apple we must reopen the PICTS.
False: we no longer reopen PICTS for subsequent review
Which type of plan get routed to 224 MAT GAT for reconsiderations?
MAHP market typ 23
True or False, The State Of Arizona (705963) get rediected to 224 PCR ADJ for reconsiderations.
False, State of Arizona policy reconsiderations get redirected to 224 PCR IPG
How many cats are there on the SME team?
6
Must we manually add the 20 days when entering in the ASO Fiduciary/Timely Filing field?
No, it is automated by ATS.
Does Timely Filing apply to Nike FWAE claims?
Yes, per the Verifying Timeliness of Filed Appeals, Nike is not excluded from the Timely Filing Process.
What are you to do if you do not see an ORS generating during the Redirection process in ATS?
If your appeal submitted by the member contains 35 ICNS with provider liability for different providers located in different cities all for the same child who is 14 years old on the policy, are you ok to redirect to single adjust using 224 PCR ADJ?
No, because the appeal was submitted by the member, reconsiderations would not apply.
This SME lives in Omaha
Melissa
What steps are you to take if you get the "Something Is Wrong" or any other funky error message in ATS?
If you encounter this, please first try the standard troubleshooting steps:
Per the latest PICTS site update, what fields can you used to search for your PICTS?
Case Type, Claim Type, Client LOB, Service Date, Adjudication Platform, Member ID
775 CSU ACN who's claims get redirected to this address?
Optum Physical Health (ACN)
Where can Purged ORS be located when reviewing for reconsiderations?
The ORSREC Report in Doc360
What is name of Brandy's brother who lives with her?
Cody