Basic Tools
Where to process claims
HRP!
Where to change your passwords
Aetna Password Management Client
Where to check if a service code requires an authorization.
NPL List
Where should you always start when working trigger 411
CCR Landing Page
What are the different breakpoints for High Dollar Review
$15,000 - $99,999.999
$100,000 - $250,000
$250,000.01 - above
Required to notate the steps you took to process a claim
Claim Comment Tool
Smart Front End, NPI Registery
Where to find correct Medcompass/HRP Denial code
Medcompass Denial Code Lookup
If you are working an Institutional claim that has a DRG, what CCR Workflow should you utilize
Institutional DRG
What are room and board codes
11x - 169
Where to find policies and workflow for triggers
(3 answers)
Epolicy, Syscoms, CRT
Where to view itemized bills, letters sent to providers, or scanned documents
ECHS/IOP
Where to look to see if your problem has been solved by someone having similar issues
Questions Database
If you are working a professional claim that does not have a DRG, what CCR workflow should you utilize
CCR Non-DRG
What is required for Leave of Absence
Need to have occurrence code 74, and rev code 18X
Where to look up contracts, view rates for service codes, provider database, and to view if a claim has been routed (1 word)
Rumba
Where to view authorizations outside of HRP
(2 answers)
Medcompass/Evicore
Pharmacy Drug Information Inquiry
If CCR decision states "No DRG intervention is required" what steps should you take to process the claim
Override 317 Denial on all claim lines and follow processing guidelines for rest of claim
What is required for an Inpatient Stay
Authorization!!!!
(exceptions: ER or TOC)
Used for deciding where to send specific claim types
Route Decision Tool
Where do you go for APC Pricing
Burgess Source
How to close a route in a CCR claim if it does not belong to you
RERT tool
What to always check on claims paying over $20,000
Itemized Bill Review Outliers