Tools and Systems
Which sender ID indicates a crossover claim?
COBA
How many days does Medicare pay 100% for SNF?
20
Explain the difference between Allowed Amount and Billed Amount.
How long does it take for the payment to be issued?
within 7-10 days of the disbursement date.
This claim is typically viewable in DocView. It means it was manually keyed into the system.
Paper Claim
This database is used by CSRs to navigate the policy information and is linked to multiple databases to make managing phone calls easier
Matrix
SNF coinsurance for days 21–100 paid by Aetna in 2026 is?
$217/day
Claim Status Code wherein you are not allowed to discuss any information.
+100 for the status.
P06 - Pre-rescind status
Payment methods for provider.
Paper Check, EFT, or Virtual Credit Card (VCC) payment
These are claims that have been processed using the SWIFT 2.0 tool. They would be considered a manually keyed claim. There will be a memo on these claims referencing the original claim number.
Paper – Web
A digital filing cabinet that stores all paper images for all departments
DocView
Foreign travel deductible is?
$250
What status code is being described below:
The claim had no remaining benefit to cover after Medicare (no supplemental liability)
D01-043
what do you call when a claim is processed but hasn’t disbursed yet?
A01-Payment Outstanding
These are electronic claims received directly from Medicare. You will use the CARC tab to view Benefits. The claim form is viewable by clicking on the claim form in the Claim Indicators sections.
Electronic Claim from CMS (COBA)
Our database that stores all recently received paper documents for all departments
Conduent
True or False.
One of the requirements for SNF is a 5 day stay in a hospital before going to an SNF.
False.
Must have a 3 day stay in a hospital before going to a SNF (except WI)
What does CO code means?
Contractual Obligation Code -
Portion provider must write off; PH not responsible.
Who is our Payment Vendor for December 31,2023 and older?
ECHO
Prior to 2/22/24, claims were sent to Change Health Care to be converted into an electronic claim. This claim is viewable in DocView and is considered a paper claim.
EMDEONPAPER
Our database that stores a variety of policy information including claims
InsPro Production
Give 3 countries that are not considered as a foreign country in Foreign Travel Benefit.
Instances when the Policyholder would receive the payment instead of the Provider.
True or False.
All payments are good for 365 days, and if a payment is not cashed within the 365 days, the payment gets voided or expires.
False.
All payments are good for 180 days, and if a payment is not cashed within the 180 days, the payment gets voided or expires.
This bot processes paper claims into electronic files and replaced EmdeonPaper.
OTIAOCRBOT