FI FAQ
This is how long claims have to process.
What is up to 30 days to process from the day they logged into the system?
Claims Escalations are assigned to this person in VUE360.
Who is Brandon Clement?
This is the list of items that you must verify 3 of in order to HIPAA verify a provider.
What is NPI, Tax ID, Name of Facility, API (otherwise known as Medicaid Provider ID), and SSN?
This is how you open a call.
What is "Thank you for calling the FI Integrated Help Desk. This is (agent name). Can I have your first name, please, and a callback number in case we get disconnected?"
For this Edit, If the member has Medicare Part B Premium (SLMB), the denial is valid.
What is 101?
This is the amount of time that must pass before a paper check can be reissued.
What is 90 days?
What template is used for the Configuration Issues?
What is Template C29?
This is the item that should be used as a HIPAA verification or search criteria of last resort on a member.
What is SSN?
This can be utilized while you research a provider's issue.
What is a silent hold?
For this Edit, if Medicare did not cover the codes, then a PA would still be required for FFS.
What is Edit 367?
This is the number of payment cycles that it takes to reflect changes to an EFT in our system.
What is two payment cycles?
Escalations on suspended claims or claims in execution require this template to be emailed to Tori.
What is "I have a suspended/executed claim (Suspend/Execution Date: xx/xx/xxxx) from <insert provider name here> with NPI <insert NPI here>. The ICN is <insert claim number here>. Can we release this claim from suspense/execution? Thank you!" ?
This is the list of items that you must verify 3 of in order to HIPAA verify a member.
What is Name, Date of Birth, Address, Member ID or Claim Number, and SSN?
These can be used to establish rapport with the caller when de-escalating a call.
What are empathy statements?
If we see a claim denying with this edit and the claim processed prior to 01/03/2025, please advise the provider to resubmit the claims.
What is Edit 1125?
This is how long it takes for us to see a MITS claim or Prior Authorization that has been keyed into the MITS portal in our system.
What is 8-10 days?
This is not done with Prior Authorization escalations.
What is the OB template is not sent with these escalations?
The acronym PHI stands for this.
What is Protected Health Information?
This should always be offered at the end of each call.
What is the reference number and additional assistance with other issues?
If you see Edit 1147 (Ordering/Referring Provider Status is Not Active), you should go here to determine who the ordering/referring provider is.
What is the Claim Header and then Providers?
This is where all psychiatric inpatient precertification (PA) requests for recipients under the age of 21 need to be sent for processing.
What is Aetna?
This must be done prior to submitting an RA Request escalation.
What is you must determine the reason that the provider cannot access the RA on the portal?
This will need to be done if a provider calls on claims with multiple NPIs.
What is a new call will need to be opened under each NPI after the additional NPIs are verified?
This is how long you should advise the provider to wait before calling us back during times of system outages.
What is 30 minutes to an hour?
The configuration issue on Edit 206 (Benefit Visit Limit Exceeded) applies to these codes only.
What is CPT codes 99202 through 99215 as well as CPT codes L5910 through L5987, D7210, D7140 T1000 and T1001?