CLAIMS
Claims that are completed will show this as the status code.
What is 02?
The code used for Non Par Office Visits and Services.
What is 99213?
1 A call is received from a provider regarding a claim status.
2 Access the Medical Claims tab.
3 Was the claim in question found?
What is Provider Locating a Claim and Claim Status?
Medicaid will always be the payer of this.
What is last resort?
She is fun, uplifting, and will always put a smile on your face. She's also a momma to two youngins and a bunch of chickens.
Who is Sarah Wine?
For claims with place of service 11, the claim will always pay to this provider, listed in this box.
What is the Rendering provider in box 24 J?
Timely for this is 3 days for inpatient, and 14 days for outpatient.
What is Peer to Peer?
If the provider has advised that they have received a recovery letter but cannot locate the letter, transfer the call to the Recovery Line at 800-727-6735.
What is Community & State Provider Negative Balance or Overpayment Inquiry?
Skilled Nursing for DSNP pays by this for INN, and pays by this for OON.
What are Levels and Rugs?
He knows you know...and he thinks you're totally awesome.
Who is Jamal Lockett?
From this tab in claims inquiry, you can see contract information and also transfer to the providers contract.
What is Line Item Pricing?
True or False. You can change the dates on an authorization that is completed and expired.
False. You can only change the dates on an authorization if it has NOT expired.
You must open the case, change the dates, and then remember to reclose the case.
Attempt to assist and de-escalate the caller. Suggested scripting: "(Caller's name), if you will give me the opportunity, I feel that I can help you with this issue."
What is Provider Services Escalation Process?
This is the tab under the member section in which you would go to find the dates that the member was in hospice.
What is the Medicare tab?
Two members of Team Deal/Nunley who had babies in 2018.
Who is Cortney and Rebekah?
Liam David- born 5/9/18
Braven Slate- born 12/11/18
True or False. It is possible in macess to enter the users name (the provider advocate) and pull all SF's that user has sent back for a certain date or date range without a claim number.
What is True?
Check the date range box at the top, put in a specific date or date range. Document type would still be CSP- Adjustment Intake Service Form.
Then go to Created by User: put in the name of the advocate (example: Galliher, Alisha) and macess will pull all SF's submitted by that advocate on those dates.
You can see the Bed Type and the Revenue Code under this tab for inpatient authorizations.
What is ICMR tab?
What is Provider- CLIA SOP?
If the provider does not want to buy and bill a specialty pharmacy medication covered under the member's medical benefit, they may order it through this network specialty pharmacy.
What is BriovaRx?
Two members of Team Deal/Nunley who are married to two members of Team Perry.
Who is Joseph Saylor and Rachelle Murphy?
You would use this tab in claims inquiry to see both the submitted DRG and the computed DRG for a claim.
What is the Hospital Information tab?
Auths that are assigned to you and must be reassigned to the correct department will show up here in ICUE.
What is HSC Work Queue?
True or False. If a non-adjustment letter is not generated and sent to the provider for an upheld SF, you send a request to PRG to have a letter loaded and sent.
False. You send the request to adjustments.
(Locating a Claim and Claim Status SOP)
True or False.
E23 & J84 are medical claim denial codes.
What is False?
These are Behavioral Health claim denial codes.
The two members of Team Deal/Nunley that live the farthest from our sup.
Who is Suzanne Dotson and Chris Liveris?