General
What are the "Other Gov" Liens?
Indian, VA, Tricare
Where do you search for a claimant?
Case Management Tab
Name the Milestones in order.
Identification/VOE, Claims, Audit, Negotiation, Finalization, Payment, Appeals (MCARE trad only)
What are typical Medicare qualifications?
65 or older, SS 24 months, permanent kidney failure, Lou Gehrig’s
What are typical Medicaid qualifications?
Needs/asset based
What liens are worked in Lawbase
MCARE Traditional & Other Gov
What does “calcs running” mean?
This is what Galaxy will show when it is updating (hourly)
Which lienholders can Epiq perform VOE and which are Self-Disclosure?
VOE = MCARE, MCAID, PLRP
Self = Private (other than PLRP), Other Gov
What criteria are common for Medicare Global agreements?
Large Claimant Pool
Large % Eligible for Medicare
Common Injuries
Within a claimant’s information in Galaxy, where would you find the lien breakdown & information?
Lien Summary
What is a HIPAA Order?
An order obtained at the project level through court stating Epiq has authority to review PHI. We do not need to obtain individual HIPAAs for each claimant unless it is an entity with specific requirements (MCAID HI, Kaiser, BCBS Michigan, mental health/abuse, Navy).
What does “SW” mean in Galaxy under Entitlement Response?
Seeking Waiver
What is the difference between Audit & Negotiation?
Audit is the process by which Epiq evaluates which claims are related to the settlement and negotiation is reducing the audited amount further for maximum reimbursement to the claimant.
What are the parameters for payment of a Medicare Traditional Lien?
Medicare must be in receipt of funds within 60 days of their issuance of the final demand letter.
Why is VOE important/preferred?
Claimants either do not remember, or do not properly disclose health insurance held during times of injury which could result in late disclosed liens as lienholders find out about the settlement.
For PLRP, there is usually an already agreed upon cap or agreement regarding reductions.
What is a recovery contractor?
A company hired by private health plans to recover funds they paid out to cover injuries resulting from a settlement. EX: Rawlings, MCAID MCOs
What is the difference between the various IDs
Case ID = Galaxy ID/claimant’s ID for particular settlement
Person ID = claimant’s ID for ANY settlement in Galaxy
Other ID = Firm
GRGID = MWB/FA
LienID = ID specific to that individual lien
What milestones does Medicare Global skip?
Claims, Audit, Negotiation
What authorizations are required for Global and Traditional Medicare?
Traditional = individual authorizations for each claimant
Global = HIPAA order or QPO covering all claimants in settlement
What are the SLAs for lienholders to return VOE?
MCARE = 30-45 days
MCAID = 30-60 days (depends on state)
PLRP = 90 days or forfeit rights
What is the difference between "complete" & "satisfied"?
Complete = lien finalized for $0.00 OR if greater than $0.00, has been paid
Satisfied = lien greater than $0.00 but not paid
What conditions must be met for a “Non-US” field on a claimant profile flip to “True”?
When claimant is a non-US citizen therefore has no SSN and a proper liability release form has been uploaded.
What does "common fund" and "made whole" mean in terms of evaluation of the plan language of Private/PLRP liens?
Common fund = lienholder will reduce by attorney F&E
Made whole = applies to certain states and means lien does not stand OR if settlement amount is less than damages
What are Medicare set asides and when might you find them?
They consider ongoing care and would typically be found within traditional cases and more commonly single event.
What is the name of the document Medicare sends which lists their claims?
Conditional Payment Letter (CPL)