UMR payment status
What issue type do you open?
Provider payment status needed
When a member is calling in for being Balance Bill what issue type do you open?
Member balance bill request
For providers calls do you explain methodology?
yes
what closures do we open payment status for?
successful Negotiation
If the client calls in with member on the line and confirms member has been balance bill, what issue type do you open?
Member inquiry
Are UMR claims eligible for further review?
?
yes
For the issue type Provider Payment Status do you auto assign or manual assign to an agent?
Auto Assign
Accolade, Quantum, and Grand Rounds,
For these clients listed above do we need a HIPPA authorization form?
No, we don't they are already authorized to speak on this claim
On a previously closed Member inquiry how do you handle the call from start to finish?
Open a Member Inquiry
Fully document the issue note.
Close the inquiry, select Internal Resolution.
Select Action Detail: Status (On Previously Closed Claim)
provide verbiage
If under 45 business days for a Successful closure:
What issue type do you open?
Do you auto assign, or do you keep issue in your name?
What closure type would you use?
Provider payment status needed issue
keep assign to self
close as Payment Status notification (can complete)
What is CEBT?
A Benefit Plan with UMR
when a provider calls in on a previously closed inquiry can you reopen the claim if they want to re-negotiate?
yes you can
if over 45 business days what are the steps to follow for a successful closure?
1. Create a Provider Payment Status Needed Issue.
2. Fully document in the Issue notes the reason for the Provider Payment Status Needed request.
3. Auto Assign.
If claim is closed as provider accepted DIS recommendation, do you open a payment status?
no because there is no change to the Allowable amount.
How would I know if the Member is considered a CEBT member?
The agent calling in will advise they are calling on behalf of a CEBT member.
•There will not be an indicator on the claim indicating CEBT.