Remark Codes
Remark code(s) when setting up an investigation.
093 998:
What can you review on a UB04 bill to confirm if a room charge is ICU or not?
The toll-free phone number needed on any letter you send.
1866-855-1212
What six steps do you take in LHCS when reviewing a new IR?
Assign the claim to yourself
Open the status if not already opened.
Add a note in the description box of the Gen Case Tab for reason case not being processed on initial review.
Label documents
Update Medical tab
Update tasks.
What does the letter T in the misc code field tell us?
When a claim contains information which should be reviewed before processing any new claims.
Remark code when you need R & B charges.
259
Add a 998-note or free-form remark code asking for an ambulance bill.
Notification sent to agent when we receive a claim for a birth.
212.6
When you make a final decision, and you are closing out your claim, you close all your tasks, remove unnecessary notes, reassign the file to the Med Processor queue, and what else before you can close the status of the claim?
Suppress the claim.
What do you need to do before making ANY entry in HICS for a claim?
GLOP check for possible duplicates, previous MCAS and / or reserve entries.
Remark code for diagnosis code(s)
264
If a bill has a statement date of 01/01/26 - 01/05/26, and an admit date of 01/03/26, what would be the From Date on your entry?
01/03/26.
Deny 01/01/26 - 01/02/26 as IN 067.
When records are ordered for a provider after a 900 letter is sent.
Advise in next 901 letter.
What information do you need to notate from Medical Records?
Chief / Principal complaint or current illness or Assessment or Diagnosis.
Actual treatment.
Referring doctors, or referrals to another medical facility or doctor.
When completing your initial call, what three main things do you need to verify (other than PHI information)
Illness or injury and onset date.
Who are their treating providers / specialists/PCP.
Are they unemployed / on SSDI / Medicare and unable to work. READ THE QUESTION DIRECTLY FROM THE APP!
Remark code when you need a bill.
260
If you receive a Claim form and incomplete bill, and the policy is contestable and you are unsure of the diagnosis, should you ask for more information or start an investigation.
Start an investigation.
Which two states require state specific wording added to letters.
Florida and New Hampshire
When reviewing for additional policies owned by the insured, which four things do you need to look at and note in your CI note.
Auto, Fire, Life and Health policies.
PNI or NI
No term date
Active status
Remark code when you need a completed claim form.
261
Which three places on a UB04 can you look to confirm an accident?
Box 30 - Accident date.
Box 66 - Diagnosis codes.
Box 72 - External cause of injury.
Letter required when you close an investigation prior to HGC review and pay the claim.
980
When do you add a baby to the policy (with a 31-day term) ?
When you receive a bill for the baby.