Bill Status
A bill is being recommended for the full amount. What are the most appropriate selections for Inquiry Type and Bill Status?
Status of Bill
Bill Recommended
Yes
How do we avoid sounding robotic?
What clearinghouses can provider’s use to bill electronically?
Waystar and Carisk
How are PA trauma bills identified?
Trauma stamp
A provider calls in needing a bill status and gives us a date of service and billed amount. We pull up the EOR and we see that it is in Draft Status. What are the most appropriate selections for Inquiry Type and Bill Status?
Status of Bill, Bill in Active Processing
What is the fax number for USAA 3rd party?
866-828-2330
What does it mean to pace a caller?
Adapting to the words that the caller uses
Who can request an IME?
The adjuster
If we see Medcre_Data, what is being needed?
SSN
A provider calls in for a bill status but the bill is not on file. What are the most appropriate selections for Inquiry Type and Bill Status?
Status of Bill
Bill Not Received
What pieces of information do I need to verify before I can give out the claim number?
Patient name, Patient DOB/address, and DOL
True or False: Saying "I don't know", "Calm down", and "I already told you" are examples of positive word choices?
False
If you are not diagnosed with an Emergency Medical Condition, your PIP benefits are reduced to how much?
$2500
What two states does Timely Filing apply to?
FL and NY
A provider calls in and asks why the full amount was not reimbursed for the billed charges. We advise the reductions were due to a PPO contract. The provider is ok with this explanation and has no further questions. What are the most appropriate selections for Inquiry Type and Bill Status?
Status of Bill, PPO Reduction
When are we able to discuss copay and deductible with a caller?
Only when it's listed on the EOR
How can we fill in dead air on a call?
Place the caller on hold, make small talk, or provide a high level overview of what you are doing without giving a step by step description.
Who pays first when there are coordinated benefits?
Health insurance carrier
When can documents be rescanned?
When they are mailed in and not past 45 days of the received date
A provider calls in about a bill and the bill is not being reimbursed. What are the most appropriate selections for Inquiry Type and Bill Status?
Status of Bill
Bill not recommended
For 1st party claims, who should we refer callers to if they want to know about the attorney information?
Adjuster
How long can we place a caller on hold before we need to check back in with them?
3-5 minutes
If a patient received physical therapy treatment from two different providers on the same DOS in New Jersey, how much does the 2nd provider get paid?
up to $105 for the daily cap
NY providers that bill DME must submit a copy of what?
Invoice to show how much they paid for equipment.