Billing 101
What type of Account can you not force to core?
House Account
What new payor became effective 10/1/18
Magellan
After OCE error and updating DOB or gender you must?
Force to reprice
An obligation to promptly report any possible violation, law, regulation, company policy, or ethical guideline.
Duty to report
Questions regarding test codes answered by this department.
Client Services
Where is the first place you check when working error codes?
The Req
For DOS 10/1 and after, Mercy Care Complete Care SMI RBHA is what payor code
4310
Which SOP states "Where the specimen was drawn will be determined by which state the referring provider is located"?
BCBS Eligibility Verification SOP
A policy that protects employees from any adverse action after reporting potential non- compliance.
Non-Retaliation policy
They post payments and issue refunds
Cash Apps
UNKPYR is what?
As of 7/1/18 any claim coming in with ASB456 should be billed to?
8136 (Meritain Health)
Which SOP states "last name is different than the eligibility record due to marriage, divorce, etc.."
Eligibility Verification SOP
Immediate Supervisor, Compliance, Human Resources, REACH Line or any member of Leadership/SLT.
This department is a combination of what used to be 2 separate departments.
Revenue Team
What is a corrected claim?
An Appeal
If XZH prefix bill payor to?
3500 (Medicare)
Per Force to EP Hold Queue SOP - what info is needed for NPI set up
ACCN#, NPI details, state
An unencrypted e-mail sent to a non-SQL or non-Banner e-mail recipient.
Possible HIPPA violation
The Supervisor of this department is Jessica DeSalvo.
LTC/CLient Billing
PR27, CO16 are?
Denial Codes
If patients have Behavior Health State Only ( Or Non -Title XIX) as well as SMI, bill to?
4314 (Mercy Maricopa)
Which SOP states " IF patient is under 18yrs of age and responsible pary/ guarantor provided key "G"
Insured Relationship SOP
Name, DOB, Client ID, Ordering Physician name/NPI, patient address, etc.
Examples of PHI
Not all orders come through this department.
Order Entry