Coding

General Principles

100

Was this presentation fun and interactive?

Yes

200

Claims with DOL's from June 1 2019 to present....

use an HCAI feed that generate the claim and claimant records on HCAI.

300

Claims with a DOL prior to June 1 2019...

Match using the claim number, customer name, and DOB to generate a match.

400

Any of the following could generate errors:

Please provide two examples.

1) Provider Treatment Mileage

2) Provider IE Mileage

3) Missed Appointments

4) Other (photocopying, parking)

500

If you receive a standalone invoice for an OCF19 you must:

Create a task to recode this payment to the proper expense code AFTER the payment is issued.

Purpose

100

Coding is to adjudicating like...

gas is to a car 

OR

ice cream is to a sundae topping

200

The left side of an OCF23 form shows:

The customer identification information from the clinic.

300

The right side of an OCF23 form shows:

The insurer's identification information for the customer.

400

CCI codes look at...

Interventions.

500

GAP codes look at:

Non intervention matters.

Adjudication

100

All invoices that are approved or partially approved on HCAI will:

Automatically integrate with ClaimsCentre

200

What are two other benefits to automatic HCAI/ClaimsCentre integration?

Automatic payments will be made.

Documents will be labelled correctly.

300

Prior to adjudicating an OCF form:

Ensure the left/right side of the information on page one matches, or use the change claimant button to fix it.

400

If a clinic uses the wrong codes on their invoice:

(ie:  they used a different code than appeared on their OCF18 or 23)

We should call them on the telephone to collaborate on a solution.

500

Payment will NOT issue when:

Please provide three examples.

NSF Reserve

Reserve Not Open

Direct Payment to Customer is made

Facility is not valid for payment

HCAI code not found

Invalid HCAI occupational code

Exposure not open

Claim not open

Invoice higher than reserve amount

Deduction higher than invoice

Claim in Do Not Pay status

Out of Province policy

Duplicate payment

Exposure/injury incident not open

Deduction equal to payment

Fun Facts

100

The Toronto Blue Jays did this by one game in 2021.

Missed playoffs.

200

The last election in Canada occurred in:

September 2021.

300

Ottawa was originally called:

Bytown

400

The first capital of Canada was:

Kingston

500

How many service offices are there in Ontario for Wawanesa?

6

Kitchener/Waterloo, Barrie, Hamilton, Thunder Bay, Peterborough, Ottawa.

Take Aways

100

We are here today to look at:

Improving coding accuracy and consistency.

200

We are also here today to look at...

Improve efficiency for processing invoices.

300

Wawanesa uses two types of codes.  Name them.

CCI Codes

GAP Codes

400

Finish this sentence:

If aspects of our _______ can be __________, it _______ be ________.

If aspects of our work can be automated, it should be automated.

500

What are our values?

Service

Openness

Fairness

Collaboration

Community