CRMs
What CRM should be created after adding insurance to patient's account?
Update Insurance Info CRM
Found in the Adding Coverage Tip Sheets
If an insurance was added to a patient's account and it was not the correct insurance, what should you do?
Change the dates in both Member periods "Effective from" and "Effective to" fields to 1/1/1900.
Found in tip sheet "Removing Insurance Added in Error"
Who can we complete a cost estimate for?
Patient's with commercial, non-contraindicated, RTE enabled insurance.
What health share plans have been confirmed that they are able to adjudicate claims?
What key will move you to the next wildcard when in a CRM?
F2
This and more helpful tips for keyboard shortcuts are found on the Epic Navigation page.
Which CRM would you create if you completed a cost estimate for a patient?
Cost estimate (RCCT Only) Crm
Found on the Cost Estimator FAQ page
When completing a VOB, if the insurance asks for the type of claim ESL will be filing, what should you say?
Inform them we will be sending a professional CMS 1500 form.
You will receive this response when the patient's DOB does not match patient on the database.
Content Error
If you have multiple patients on the line, what should you do regarding HIPPA?
You MUST follow the standard 3rd party permission workflow to get permission from both patients to speak with the other person on the line.
Document each patient's account using the 3rd party caller CRM.
If a provider calls to update the ICD codes on a lab requisition order, where will you navigate to, to update these codes?
Navigate to Patient Station, select the correct lab requisition, and select the button "Requisition." Under orders and Diagnoses, enter the ICD code/s as requested in the Add a diagnosis box.
What CRM should be created if a refund request was submitted but a patient calls back to inform us the original form of payment is no longer active?
Cash Refund Request CRM
Found on the tip sheet: Patient Refunds- RCCT page 5.
When completing a cost estimate, if you see a yield sign in the patient pays box, what does this mean and what steps should you follow?
There is likely an RTE error that needs to be resolved. Return to Registration. Review Response History. Confirm all insurance information with the patient and update if needed. Rerun RTE. If we are unable to receive an Eligible or E-verified RTE response, offer a VOB.
This is found on the cost estimator page under troubleshooting
Add the contested account billing indicator.
Navigate to Guarantor account. Select the Account tab. Select the Account ID Hyperlink. Select the Account Activities button. Search for Modify Billing Indicator. Enter a detailed note. Search for Contested accounts. Select the add button. Select accept.
What is our place of service code and what does it stand for?
81 and independent laboratory. This will be used on the CMS 1500 claim form.
Where can you go to see if an RTE has been sent?
Navigate to registration and click on the Response History tab. From there, click the Coverage Eligibility tab.
What CRM(s) should be created the first time a patient is provided an appeal letter?
Appeal Letter CRM and the Negative Feedback CRM with subtopic, Payor Didn't Cover Test or Received Bill.
Found in Appeal Process Tip Sheet
The status of "Contact Payor" appears when?
When attempting to verify an Unenabled Payor on the verification checklist. When this does appear, eligibility must be investigated more deeply by teams with access to payor portals.
This is found in the tip sheet. RCCT Real Time Eligibility.
If a Medicare part A and B patient is contraindicated we MUST go over all 3 options unless:
The patient declines testing or the patient elects to wait for 3 year rescreen date on Frequency gated orders.
If an insurance requests medical records, what team do we send this to, to send these out?
Ha! This was a trick question. ESL does not send medical records. Insurance will need to contact the provider's office directly for that information.
What is a good tip sheet to use to better understand the coding presented on an EOB?
ANSI CODES and CARCS/RARCS
What CRM will I create if an account is in bad debt and the patient wants to establish a payment plan, is requesting a statement, etc?
Cash Follow-Up
This is found on the RCT/ Cash Follow ups page. You can also find this information on the Bad Debt FAQ Page
This might indicate that Cigna is the pricer. We would want to verify this by following the Cigna as the pricer tip sheet.
If a patient wants to self pay for a test, but we are still waiting for the advanced determination approval or denial, what can we do?
AD denial is no longer required prior to accepting payment. Advise of Medicare coverage guidelines and the AD process. Advise if they do not wait for the AD to be completed they will not be able to submit for reimbursement later. Confirm patient does not want their insurance billed and wants to pay out of pocket. Collect pay as usual. Document.
If a Client Bill Provider is calling with questions about a statement, kit shipment, and/or wanting to make a payment, what should you do?
Create the Client Bill Follow-up CRM and ensure you complete all wildcards.
Where do you look to determine the status of the AD request?
1. Check the documents section in Registration.
2. Check the History tab in guarantor summary for notes left by the AD team.
3. Check the statements/letters tab to view letters that have been sent to see what has been communicated.