FOVS
This is what you do when BRC Handling is set to No.
What is nothing?
For NY Bills, what must be done if a bill cannot be paid for any reason?
What is set to "CP Review Needed"?
This must be done if the subfile on a claim has been closed for 181 days or more.
What is set a diary for the CP to reopen and set reserves so payment can be made?
This is the disposition used when a bill is committed and all lines are reduced to $0.
What is denied?
This is the first thing we should look at when opening a bill in Mitchell DP.
What is the AFO?
This will provide specific instruction regarding frequency, duration, allowed amount, payment direction, etc.
What is a treatment card?
This is the Pay Authority for NY bills.
What is $5,000?
This is where we can manually add a deductible, split coverages, or add apportionment.
What is the Exception Queue (XQ)?
This is the disposition used when the CP requests a bill back or we need to send it back due to jurisdictional guidelines.
What is CP Review Needed?
This status reason should be used in Mitchell DP when a bill is released with a delay for an Independent Medical Examination (IME).
What is "Pending Verification"?
This supersedes any other direction given in FOVS.
What is CP Directives (at the bottom of the page)?
The rule for paying ER services from the Date of Loss.
What is 7 days?
This action should be taken if a third-party biller requests payment be made to the provider directly
What is set release bill?
This is the disposition used when we are asking the CP for something.
What is "Route to Exception"?
This is sometimes referred to as a signature on file and will let us know if there is direction to pay the provider or not.
What is an Assignment of Benefits (AOB)?
This should be set when benefit exhaust and the CP indicates BRC is allowed to.
What is the Treatment Adjustment Card (TAC)?
This should be done with bills that are in "Peer" or "Pending Verification" statuses.
What is leaving the bills untouched?
This action should be taken when MRT applies an x303 endnote due to improper codes or missing provider information.
What is deny with endnote x303 and x998 (with copying the MRT notes into the custom comment box)?
What is an "Exception Reason"?
This should be done if a bill exceeds the $10,000 Pay Authority ($5,000 in NY).
These types of diagnosis codes are okay to pay even if not listed in FOVS.
What are General Diagnosis Codes? (Radiculopathy, General Pain, Segmented and Somatic Dysfunction)
These treatments can be paid as long as other criteria is met and records are received even without a treatment card. (Hint: there are 5)
What is Chiro, Massage Therapy, Acupuncture, Physical Therapy, and Occupational Therapy?
In this AFO we can only deny per FOVS or return to the CP.
What is 732, Turo?
This disposition should be used when partially denying a bill.
What is Approved for Payment?
This is the term used when a bill is released without generating an Explanation of Benefits (EOB).
What is N'Pay?