Insurances
Who is considered the payer of last resort?
Medicaid FFS
What team do we escalate in order to have modifiers JZ & JW reviewed?
CDM Team
What is CARC code 197 used to indicate on an EOB
NO authorization
If you go to Nicole with an account question what is ALWAYS her first response?
DID you check ONE NOTE?
What is the maximum amount of medical records requests we can send to Adrienne in one email?
20
How many days does it take to update ins in RC9U?
2 Days- 1 for update and 1 for verifying update
What is the claim for we bill on?
UB04
What is CARC code 55 used to indicate on an EOB?
Medical Necessity
Where does Annie's MOM live?
FL
How many times should you "touch" and account
3
What does MSP stand for?
Medicare secondary payer
Name one stat charge code description ( BONUS for the actual code)
:)
What is our NPI, TIN and address
:)
What is Christine's son's name?
Ethan
What is the MAXIMUM allowance $ amount staff can adjust without involving their supervisor?
$74,999.99
Who is responsible for LABS with the NYCK split plan?
GHI
What allowance code do we use to move $ from ins to pt?
503151
Name 3 things that MUST be included in an RIRV comment for a no auth account
See Annie and Nicole LOL
What Does OON stand for?
out-of-network
Name one person in the office you can call when you cannot come in besides Annie, Nicole, or Christine.
ANY 3 or higher in the office
What insurance requires we bill with value codes?
Medicaid and Medicaid HMOs
What program do we use to calculate payments?
PIC
Who is responsible for EMBLEM JOC
Janene B
What is a POA indicator
Present on admission diagnosis
What is an SCA?
Single case agreement