Entering a Dispute Sequence
What action code allows the collector to pull the Dispute Summary screen?
DA
What is the standard turnaround 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 name of the sheet tab used for rejected/denied line item/s in the 835/EOB to code your dispute sequence in ACE?
Payer Group Tab
What Activity Code is used if you need to submit a request to rebill Primary Insurance with a corrected claim and copy of Implant invoice?
XX142
What is the name of the complete five-character identifier for a specific payor/insurance company selected by admitting rep and or Specialist to secure payment on accounts?
Plan Code
What code identifies the issue causing the Dispute?
RC - Root Cause Code
What activity code is used to cancel your Facility assignment request?
CHCXL
What is the name of the sheet tab used if your 835 reflects CARC 45, no RARC and 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 Tenet M - Codes
What rebill activity code is used when submitting a request for an initial/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 are the 2 Input Fields you are required to update for the correct Rapid Response routing instructions.
The Facility ID and Reason Description
When using Contractual Variance Tenet M - Codes sheet tab, what application do we need to use to determine the METHOD and SERVICE TYPE?
Finthrive
What rebill activity code is used to submit a 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
If a dispute is loaded on an account incorrectly, is a collector required to load a new dispute sequence or can you simply modify the current loaded Dispute?
No, you can modify the current record if the dispute has not been appealed.
How can a collector identify completions and rejections from facilities in ACE?
Review Shift + F4 Billing status history (look for ISRXX activity Codes), Primary Status Code QSP/386
If an OP claim is expected to pay $1289.00, Finthrive shows the expected is “ALL OP” service type per MCR_OPPS, how will the Dispute Category, Dispute Reason and Dispute Root Cause Code de loaded in the DA screen?
Category: M (MANAGED CARE/PAYOR ISSUES)
Reason Code: M703
Root Cause Code: MR079
Disposition: U
What rebill activity code is used to submit rebill 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
No authorization, Not medically necessary, Level of care and Contractual/Payer denials/discrepancies are examples of what type of Dispute?
True/Active Dispute, which requires a verbal or written appeal for reconsideration.
You are working Facility Code, AHD. The account you're working on is a BCBS who is denying Procedure Code (CPT) 83735 for LCD error. What is the appropriate Activity Code used to delegate the account through Rapid Response.
BRMGR (applies to PC 70000-99999 Range)
An IP account has received an 835 with a CARC code# 15, no RARC code. You review the account notes & learn, no auth was obtained at the time of registration. BCBS denied for no authorization. How should the Dispute Category, Dispute Reason & Root Cause be loaded as per the Denial Coding Matrix?
Category: X (Clinical)
Reason Code: X571
Root Cause Code: XR001
Disposition: U
What activity code is used when we need to rebill the primary insurance after we made an update to insurance demographics such as Insurance Plan Code, Address, Group number etc.?
XXUPD
What digit/digits in Payor Plan Code identifies the third party paying the claim?
1st three digits