Eligibility
What 3 points of Beneficiary information are REQUIRED before giving eligibility
Any combination with AT LEAST one Numeric element:
Beneficiary First Name
Beneficiary Last Name
Beneficiary Middle Name/Initial
Beneficiary SSN
Beneficiary DOB
What tab in ClaimsXM 360 do you see the Other Heath Information?
COB Tab
When a claims denies for "Definite Duplicate Claim" (CDD) what are the next steps
Request a Reopen/Walkthu or Caller needs a Corrected Claim
Giving eligibility before FULLY verifying the Beneficiary's 3 elements of identification?
A No Go
Often hailed as the “King of Pop,” this artist’s iconic career includes the best-selling album of all time, “Thriller.”
Michael Jackson
When a member reaches 65yrs old what documentation do they need to send in to stay eligible?
Medicare Card (SSA Letter)
Where is the Patient Control Number in ClaimsXM 360?
On page 2 on 360 main screen under Submitted Data.
When a claim denies for "EOB type on claim does not match" (W26) Where do you look to verify this information?
Providing a CPT/procedure code to a caller.
No Go
What is the largest mammal on Earth?
Blue Whale
If a child Beneficiary is 22 yrs old and is not in collage, is this member eligible with ChampVA?
No
What information can you find in the Clinical Edits Tab in Claim XM 360?
Additional information on Denials
When a claim denies for "W02" what are the proper procedure steps to follow?
IF Med Recs on file: Send back as Reopen Referencing where Med Recs can be found.
IF Med Recs not on file: Advise caller to send in clinical documentation with corrected claim.
Joe advises the caller "We aren't able to look up claims that old"
No-Go
In what country did the first Starbucks open outside of North America?
Japan
Member is a spouse over the age of 55 and remarried would this member still be eligible with ChampVA?
Yes
Where do you transfer to verify a Facility's Remit Address in Claims XM 360?
Transfer to Facility
Where do we want to look to see if a W40/W41 denial has been resolved/terminated?
Sponsor is calling in on an application sent to us and Joe marks the call as Non-Core?
No-Go
What does SPF in sunscreen stand for?
Sun Protection Factor
Can a Veteran be a ChampVA member?
Yes, but only if their Spouse is a Veteran and neither are eligible for Tricare.
What 5 things do you need to input when sending a claim back for a reopen in CXM?
Click note Claim Number
Put Reference Number in the Summary
Change Status
Change Reason
Input notes (Denial-Claim Number-Reason sending back)
What scripting do you give for "Required Px or Mod is missing or invalid" (W71)
This claim either contains an invalid Procedure Code or Modifier or is missing a valid Procedure Code or Modifier. You'll need to reach out to your billing and coding department to verify the claim is billed properly and send a Corrected Claim
GO
What was the coffee shop named in the hit TV show Friends?
Central Perk