Insurance
East, West, Prime coverage
Tricare
Payor of last resort
Medicaid
This team handles charges that need to be dropped to allow payment to be disbursed to account
Patient Access
The CPT code used for Cologuard
81528
You will receive this response when the patient's DOB does not match patient on the database
Content Error
The type of document needed for Anthem VA HMO/POS plans to lift kit gating
In-Network Exception
Requires ABN for contraindicated orders
Medicare A and B
This team handles timely filing errors made on our part and the patient should not be billed
PFS (Patient Financial Services)
What are the 3 different ways we are able to check for coverage for a patient's CG test?
Cost Estimator, 3 way VOB, 2 way VOB
True or False: Patients are allowed to set up a payment pre-pay plan and a post payment plan?
False
ID does not start with U, adds "00" at the end of the ID # if ran through RTE
Cigna as Pricer
Requires AD for contraindicated orders
Medicare Advantage
The leads you would message to reverse an account that has a sent to agency flag. (Bad Debt)
Sandra Kamarainen and Shelly Groeschel
ESL is listed on the ancillary list with this insurance plan because there are 2 different addresses listed.
UHC (United Healthcare)
This is how many attempts we make to reach the patient when working WQ 1777.
1
We offer this to patients who express hardships to cover the cost of the CG test.
Financial Assistance
Coverage that only covers hospital claims and does not cover CG
Medicare Part A
This team handles any CO adjustments on patient's EOB
Patient Financial Services (PFS)
We are UNABLE to do a VOB for these 3 insurance plans.
BCBS Tx, Anthem BCBS Virginia HMO & POS, and Indiana Teamsters
These are the 2 most common CPT codes covered by insurances for CG.
Z12.11 and Z12.12
A claim that was routed to BCBS WI but was supposed to go to BCBS AZ
Alt Payor Logic
Healthshare plan that can actually properly process and adjudicate claims
Medi-Share
This CRM is created when AD process was never started but patient was billed.
Extra 50 points: What task will you add?
Advanced Determination Notification CRM
You will add the Review AD notification Task for the AD team
We only offer a VOB with this insurance if patient threatens to cancel test
Medicare
This is the standard processing time for an account review.
90 days