Rev Cycle 101
What documents explain why a claim was denied or underpaid?
EOB or Remit
What is the minimum dollar threshold to escalate to the JOC?
$100
Any and all documentation related to claims, needs to be scanned into what system?
RASI
Name two insurances that required a reconsideration form
Aetna, United Healthcare, Anthem
On the Bridge of Khazad‑dûm, this wizard stands alone against a Balrog and declares, “You cannot pass!”
What must always be correct before escalating or appeal a claim?
The expected / remaining balance
What is missing from this JOC Note:
HIP CL#26048576842 (1/30/26) DOS TOTAL CHRGS: $29675.84. DOS EXPECTED: $23740.67. CPT J1569 PD @ 50%, SHOULD PAY 80%. HIP PD $12571.92 PT RESP. SHOULD PAY $20115.07
The remaining expected amount.
Name the two systems that can be used to determine if a claim was paid correctly or not.
Contract Management and PIC
What do R12/R14 denials on Cigna claims represent?
Inclusive denials
In Star Wars, what weapon is described as "an elegant weapon for a most civilized age"?
A lightsaber
What three portions make up the patient responsibility?
Copay, Coinsurance, and Deductible
True or False?
The reference number goes in the JOC Tracking Number field
False. Only JOC staff use the JOC Tracking Number line. The reference number goes on the JOC Internal Ticket line.
Images, such as insurance cards and driver's licenses, can be viewed in two Cerner systems. What are the names of the two systems?
Powerchart, and PM Office.
True or False, Anthem NYC allows for a maximum of 40 visits for cancer treatments per calendar year.
False, NYC plan allows for 30 visits per calendar year.
In Game of Thrones, what substance (besides Valyrian steel) is known to kill White Walkers?
Dragonglass
What is the difference between the governmental, and non-governmental 28-record codes?
Non-governmental ends in 98, and governmental ends in 99.
If multiple JOC activity codes apply to the claim, how do you determine which one to use?
You use the code tied to the highest dollar amount.
Name two systems that will allow you to pull and itemized bill
RAS Viewer, and PIC
How many days does HIP have to review an appeal or medical records before it is considered approved for the full payment?
Appeals and medical records must be reviewed within 60 days or they are considered approved in full.
In Star Trek, what is the name of the rule that says Starfleet shouldn’t interfere with less‑advanced civilizations?
The Prime Directive
What dollar amount is considered "Extremely High Priority?
$100,000 or more.
Per the new JOC guidelines, UHC has four plan codes listed that cannot be escalated. Name two.
M31 (Medicare HMO), Y75 (EP 1 & 2), Y89 (EP 3 & 4), and Y90 (EP 200 - 250)
A patient was seen at SBUH for physical therapy. Anthem denied their claim stating they need a qualifying service. Name one qualifying service, and in what system you can find it.
OP Surgery, or IP Stay. Schedule Appointment Book.
When updating to or from Commercial / Medicare / Medicaid plans, what must always be done after updating Cerner and RC9U
The account needs to be sent to CDM to check for 340B pricing.
In standard rules, long rest mechanics usually restore most hit points and abilities; how many in‑game hours does a typical long rest take?