Adding a Dispute or Corrective Action
From your Financial Reconciliation (BU) screen, what function key can be used to quickly access the Dispute Summary (DCM) screen?
F5
What activity code is used to cancel your Facility assignment request?
CHCXL
This tab in disputed claim denial coding matrix spreadsheet is used for rejected/denied line item in the 835/EOB to code your dispute in ACE?
Payer Group Tab
When the Primary Insurance needs a corrected claim with an attachments, what rebill code do you enter?
XX142
What is the complete five character identifier for a specific payor/insurance company selected by admitting rep to secure payment on accounts?
Plan Code
What action code allows the collector to pull the Dispute Summary screen?
F7 then DA
You are working Facility Code - AHD. The account you're working on is a Blue Cross and Blue Shield who is denying procedure code ( CPT ) 83735 for LCD error. What is the appropriate QS code to use to delegate the account through Rapid Response?
BRMGR - CPT 70000 - 99999 range
This tab in disputed claim denial coding matrix spreadsheet is used if:
1. plan has underpaid per the contract
2. no denied line items
3. balance is not the patient responsibility
4. variance still exist
Contractual Variance - M codes
Contractual Variance Tenet M - codes
What rebill activity code is used when submitting a request initial or rebill for secondary insurance with primary EOB/remit only?
CRSIB
What Action code is used to initiate PBAR Plan Code Update?
F7 then DE
A Non-active disposition identifies what type of dispute is loaded on an account?
A Corrective Action, which needs additional collection work efforts for resolution
What is the standard turn around time for a QS/Rapid Response request?
They can reply within 24 hours, however requests can take up to 3-5 days.
What is the definition of RARC?
Remittance Advice Reason Codes
What rebill activity code is used for any rebill to the primary insurance with other attachments?
CRBWA
True or False: You can make Financial Class changes towards the end of the month.
False
What code identifies the issue causing the Dispute?
RC - Root Cause Code
What is the name of the tool that is connected in “real time “ with ACE and is an automated work listing tool in a web-based application for facility responses required to satisfy pre-bill, and disputes necessary to send bills and rebills to payers?
Rapid Response
What is the definition of CARC?
Claim Adjustment Reason Code
It is a rebill activity code for primary insurance when we need to send a corrected claim without an attachment
XX141
True or False: We can update patient name, date of birth and SSN in ACE?
False
If a dispute is loaded on an account and you identify the dispute was loaded incorrectly, is a collector required to load a new dispute record or can you simply modify the current loaded Dispute?
No, you can modify the current record as long as the dispute has not been appealed
Where can you locate completions and rejections from facilities in ACE?. Must give all 3 locations.
1. Summary notes
2. Activity code notes search
3. Billing status history
When using contractual variance Tenet M - codes tab in disputed claim denial coding matrix, what application do we need to use to determine the METHOD and SERVICE TYPE?
Finthrive
What activity code is used when we need to rebill the primary insurance after we made an update of insurance demographics such as insurance plan code, address, group number, and etc?
XXUPD
What digit/digits in Payor Plan Code identifies the third party paying the claim?
1st three digits