Aux Codes in Max Agent
This is the Aux that you start off in when you first log into Max Agent.
What is Unavailable?
This is the timely filing limit after date of service (Medicaid primary) to file a claim.
What is 365 days?
You should be telling providers about the CARC/RARCs on a claim
No, you should not be providing CARC/RARC information.
Although we can see the CARC/RARCs, they provide generic information that does not always speak to the accurate denial reason.
We should stick to reviewing the edits and following the information for the specific edit.
This is how long you should put a provider on a silent hold unless you've set a different expectation.
What is 30 seconds?
This is what you need to do if you see Edit 153 (PCP is solely responsible for service: pay as capitated) on a claim.
What is refer the provider to the MCE?
This is the Aux that you use for whenever you're going through uptraining.
What is Unavailable: Training?
This is the Payor ID for Ohio Medicaid FFS.
What is MMISODJFS?
Finalization means what?
Claims in pay or deny status typically move to Wait Pay or Wait Deny during the weekly cycle. Reversal claims move into a wait Rev status. These are claims awaiting finalization and are generally included in the provider’s next payment after they become finalized. These claims are locked and they cannot be edited.
This is the goal for the amount of time it should take to wrap up a call after speaking with a provider.
What is 30 seconds?
If you see UM Not Found (Edit 606) you should do this in the Pay tab.
What is view the authorization number listed?
This Aux is only used when you're going to a team meeting.
What is Unavailable: Meeting?
This is a type of Medicare that covers member's doctor visits.
What is Medicare Part B?
Medicare Crossover Claims Are All Crossover Claims right?
No. All Medicare claims are not crossover claims, but all crossover claims are Medicare claims.
Providers have the option to manually/electronically submit their claim or to use the Medicare Crossover option.
This is the percentage goal for quality and can be reached by reviewing your evaluations to ensure that you are focusing on your areas of opportunity.
What is 90.50%?
You should check here on the claim if you see Edit 915 (Claim has been manually denied).
What is the memos/attributes of the claim?
This Aux is used for your 15 minute break.
What is Unavailable: Break?
This is the Ohio Medicaid BIN Number for Pharmacy.
What is 024251?
Timely Filing Limit after Discharge?
Providers have up to 365 days after the date of discharge to submit claims.
This is the goal for AHT (Average Handle time) which is a combination of your talk time, hold time, and wrap time.
What is 575 seconds?
If you see edit 6239 on a claim, you should do this.
What is complete a claim escalation to Brandon in VUE360?
You should always use this Aux at the end of your shift.
What is Log Out?
These payments are made on claims that include T codes, G codes, and/or DME codes and are paid via waiver dollars.
What are wraparound payments?
When you see copy it means...
It copies entire data from the claim except the data returned from payer. New claim will be same claim type as original. For example, dental claim can be copied to create only dental claim.
This is your adherance percentage goal.
What is 92%?
If you see edit 6029 (Future DOS End Date for DME) on a claim, you should look at this first.
What is the date of service on the claim?