PAYMENT EXCEPTION
This PE type is triggered when no payment information is found or the selected payment method is declined.
What is Payment Settlement?
This is the minimum productivity expectation for PAs per hour when assigned to the red scheduled task.
What is 10?
New patients must be worked daily with at least this minimum number of outbound calls.
What is one (1)?
This PE type occurs when an order is adjudicated and the insurance rejects the claim for any reason.
What is a Failed Claim?
This is the very first action you must always take before starting a PA key.
What is run a test claim?
Prior to starting the queue, one person is assigned to run test claims on these drugs on the Scheduling New tab.
What are Null Margin drugs?
This exception occurs when an order contains multiple claims and at least one rejects while others process successfully.
What is a Failed Claim – Partial?
For any item with an Aging of 1 or older, a PA key must be started daily by this exact time.
What is 12:00 PM?
The full Insurance Queue list must be worked on these three specific days of the week.
What are Monday, Wednesday, and Friday?
This error requires review and patient verification because the amount the patient owes is higher than what was authorized.
What is Patient Pay Amount Exceeds Authorized Charge?
For Bertha's commercial patients mandated to another pharmacy, you must instruct the provider to do this with the Rx.
What is reroute to the mandated specialty pharmacy?
To successfully remove an order from Benefits Investigation and the Insurance Queue, you must mark it as this.
What is Denied (Reason: Other or None)?
CRITICAL: You must never work this claim type; instead, immediately message Brad or Jasmine for correction.
What is a Failed Claim (Reverse)?
Template codes 147 and 384 must be entered with a value of 1 for this specific rejection type.
What is Medicare residence / service type?
CRITICAL: You must never use an E1 request unless the patient meets this specific age criteria.
What is 65 and older?