Starting a file
When you pull up and invoice and no phone number is located on the file, this action must take place.
What is a TIN/NPI search.
A provider is stating that they billed the OI (commercial) and the OI denied. This information is needed regarding the OI claim in order to write off the file.
What is the EOB and/or call to the OI for a reference number?
This client has to have their claims sent over for retraction 30 days from the final letter, no matter what the status of the invoice is.
What is Aetna federal invoices?
The provider advises that the claims were billed. This information is needed in order to move the claim status to a billed status.
What is the billed date from the provider?
When searching for a direct with this client, once you have received direct information, email the PIA direct to see if they can confirm. With this client, we can confirm directs easily and the PIA and process the remit.
Who is Aetna?
This action must be taken as soon as the file is worked for the first time. This review should actually be done on all invoices before you make your first touch, even on your follow ups.
What is the searching the restriction list.
This needs to be included at the end of your remit note before you submit to the TM for approval.
What is the Reps initials?
For these clients, we can only send claims over to be retracted if they are 1 year under the paid date for the claim. It does not matter if they are provider requested or not.
What is Centene and Healthnet?
What is the address and fax/email to send the letter to?
For this client, For this client, 30 days after the check has been sent and you have received direct check information from the provider, you need to submit it to ARDdirects to see if we are able to locate the direct and check copy in the client system.
Who is Cigna?
You receive a new invoice and the amount of the invoice is $752.00. What action do you take on the invoice?
What is call the provider to provider OI information and find what address and fax/email the letter can be sent to.
This client cannot be sent to the write off queue, rather it needs to be sent to the TM when we need to close the request down.
What is Kaiser?
These clients, we can take verbal provider request for retraction over the phone, but we have to have the phone number and the name of the person that requested it from the providers office.
Who is GHI and HIP?
This should be a first call on a follow up invoice that is not in a paid status. The information gotten from this call is used to base the follow up call to the provider.
What is a call to the OI?
For this client, we must place the invoice and claim status in direct pending for two weeks. If the claim does not move to have fees posted within those two weeks, then we move the claim to the lost directs spreadsheet for the client to review. If it is not located on the lost direct spreadsheet within 60 days, then reach out and have the PIA check again.
What is Kaiser?
What is call the provider to provider OI information and find what address and fax/email the letter can be sent to.
What is a the Medicare Eligibility call?
You are writing off a file due to uncooperative provider. These four items are looked for in your remit note by the TM in order to approve.
What is has the letter cycle been completed, did we escalate, was a TIN search completed and have we verified with the OI the claims were not billed?
You can locate the information that a claim is retractable with a provider here.
What is the claim details?
These pieces of information are needed to in order to move the claim status to a paid status in SMART.
What is the paid date, the paid amount, patient responsibility?
For this client, if we are able to obtain a copy of the cancelled check, the PIA can process the remit for the claim.
Who is Oscar?
You make the first call to the provider, and you receive an unnamed voicemail or the number is no longer a working number. This step is the next step you should take.
What is conduct a TIN/NPI search?
What is has the letter cycle been completed, did we escalate, was a TIN search completed and have we verified with the OI the claims were not billed?
What is two searches?
What is expected minus debit?
This information is needed in order to move a claim to a direct pending status.
What is the check date, check amount, check number? If possible an address and a copy of the cancelled check as sometimes it is needed.
For this client, the PIA's can see directs and retractions but cannot process a remit. Once you receive direct/retraction information, you need to flip the claim to direct pending and finance will review with the client for confirmation of the remit.
Who is Centene?