Week 7
Clear this issue by modifying the ICD code order and/or the primary ICD code
What is the normal expectancy?
The correct way for an authorized representative to sign claims
What is John Doe by Jane Doe (Claimant's name BY authorized rep's name)?
The eligibility business rule fail due to clmt returning to work for a new employer.
What is NER?
Does not qualify for DI due to profit loss instead of wage loss
Form needed to be sent at first pay when claim is WC.
What is 78G?
These circumstances resolve the labor market issue when the claimant left work due to layoff, quit, or termination and the period between LDW and disability beginning is beyond 90 days.
What is pregnancy, mental condition, or drug/alcohol illness?
DE2522 is sent to the heir when claimant deceased prior to signing 2501. Name the forms sent to the heir when the claimant deceased after signing the 2501.
What is DE648 and DE5128?
When DQ 1722 is sent due to receiving full wages, the DQ period should be divisible by what?
What is 7?
The departments responsible for making the determination of eligibility for overlapping periods
What is UI and PFL?
This provider's scope of practice is not limited because they are equally uneducated in all fields of medicine.
What are religious practitioners?
CED requested is 01/01/2021.
P/P's DDB is 01/06/2021.
EDD is 02/04/2021.
Determine the CED
What is 01/01/2021?
Gap between CED and P/P's DDB is less than 7 days, there is no need to investigate.
CED 01/01/2021. Clmt has 3 ERs: TacoBell, Wendy's, and Jack in the Box
03 from Tacobell states sick leave from 01/01/2021 to 01/17/2021. Holiday 01/18/2021. Vacation 01/21/2021 to 02/02/2021.
03 from Wendy's states: sick from 01/01/2021 to 01/10/2021 and is LSDI
03 from Jack in the Box states: bonus for 03/02/2020 to 12/31/2020 and severance pay paid as lump sum
Determine the conflicting wages.
What is sick leave and holiday pay from Taco Bell?
Clmt with WC injury rec'd TD benefits for 3 years. Clmt filed for DI with CED of 01/21/2021. DOI is 02/20/2018. Determine the comp year
What is 8 (1216)?
When are Licensed Midwives and Nurse Midwives permitted to certify?
What is normally anticipated periods of antepartum and postpartum disability? (normal pregnancies)
Claim CED is 01/01/2021. PX is 03/01/2021. Claim has a disqualified period for 1713 from 01/20/2021 to 01/29/2020. Medical rec'd confirming clmt under C&T during that period. Pay this period with action, reason, and dates. 17RD will be sent
What is action Redet with reason 1713 from 01/20/2021 to 01/29/2021?
What is action Qualification with reason REDET from 01/20/2021 to 01/29/2021?
To obtain the correct Normal Expectancy for a pregnancy claim, DIPR must enter the estimated delivery date in this field.
What is Latest Significant Medical Event Date (LSMED)?
Actions screen
WP 01/01/2021 to 01/07/2021 Q 01/08/2021 to 01/20/2021 DQ 01/21/2021 to 02/03/2021 1722 Q 02/04/2021 to 03/03/2021
No 03 rec'd.
clmt calls and verifies worked on 1/21/2021, 01/23/2021 an 01/27/2021. Gives you R&C.
List all of the updates you make before qualifying the previous DQ period.
What is redet, what is update R&C, what is update RPU?
The minimum number of years the DOI is prior to the CED in which a lien is not filed.
What is 5?
Clmt's LDW is 02/02/2021. Requested CED is 03/02/2021. The reason they stopped working is to attend school and is not looking for work.
What is LM withdrawn?
The immediate result seen in the action screen when you inactivate a blockout period.
What is waiting period shift?
The two tabs that need to be updated to match when TD and PD letters are received.
What is RPU and WC?
CED 01/01/2021. PX 05/05/2021 BLOK 01/01/2021 - 01/12/2021 WP 01/13/2021 - 01/19/2021 Q 01/20/2021 - 02/05/2021 Inact the blocked period and WP shifts to 01/01/2021 to 01/07/2021
Pay this claim with the correct reasons
What is Q 01/13/2021 to 01/19/2021 reason CED
The most definitive form of duration management we can exert.
What is IME?
The type of prognosis a claim has that allows the prognosis to be adjusted.
What is variable prognosis for vaginal or C-section delivery?
Situations where self-employment is not an issue
what is stop-gap self employment and self-employment after establishing a claim?