Tools
This tool keeps the schedule of the agents - lets them know when to take breaks, lunches and their phone times. Also used to plot schedule exemptions within the day.
IEX
True or False. All claims submitted to BCBSMI will be reviewed by Optum.
FALSE
What medical records are needed if the service billed is a "complete blood count" (CBC)
physician's order and lab results
What is the operating hours for BCBSMI?
8:00am – 8:00pm EST Monday – Friday (excluding Holidays)
Search engine for job aids of PIRT.
Knowledge Now
True or False. After an initial denial, providers have 60 days to submit a reconsideration.
FALSE.
In general, what service was performed if the first digit of the CPT is "0"?
Anesthesia
How many appeal rights does a provider have?
1
The tool that stores cases and clinical outcomes for both professional and facility claims.
OPRS
Effective this month, what are the 3 metrices for QVC?
sentiment score, Adherence and ACW
This describes services whether it is medical, surgical or diagnostic and is designed to communicate uniform information about medical services among physicians, coders and insurances for administrative, financial and analytical purposes.
CPTs
What is the timely filing for medical records for initial review?
60 days -- If records are not received in 60 days from the date of the first request letter, the case will close. This is a technical denial.
Used to provide definition or description of CPT codes, HCPC codes, ICD10 codes, modifiers and revenue codes.
Knowledge Library
How can providers submit medical records?
Mail and online.
Also known as alpha-numeric codes since it contains a single alphabetical letter followed by 4 numeric digits.
HCPCS Codes
What is the timely filing for reopening a case after a technical denial?
18 months from the original BCBS of Michigan processing date.
The name of BCBSMI virtual portal
OKTA
Yes or No. We can create a ticket for 2nd look if the provider disputes an initial review denial.
No. Verbal dispute is not allowed. A reconsideration must be submitted in writing.
In general, what is the best answer if callers ask us what kind of records to submit?
“We need to have records pertaining to the codes that were billed on the claim.”
True or False. The provider can request for a verbal dispute.
FALSE.