Bulk Issues
True or False: For Aetna COB accounts, are you able to send accounts back through the COB department?
True
What is the name of the teacher from the famous children’s show, “The Magic School Bus”?
Ms. Frizzle
True or False: BEU Feedback Workflows should be assigned to the Senior Support Specialist.
False, while the initial instruction was to send Feedback workflows to the Senior Support Specialist role, the current process is to assign 1 of 3 Feedback item types (Document Retrieval, Workflow Error, Other) to Support Specialist to provide Feedback to BEU.
Which day is dedicated to “Sprint day follow-up"?
Tuesday
True or False: NCTAP and 20% DRG Bump rules were implemented and issued by Blue Cross Blue Shield of GA.
False, the ruling was issued by CMS (Center for Medicare/Medicaid services)
What is the name of the university Mike and Sully from Monsters Inc. attended?
Monsters University
When an AI, A2, or Global Analyst concludes that an account is paid correctly and should be unbilled, who should the workflow be assigned to based on the underpayment?
W/O Senior for <$50K and W/O team for >$50K
True or False: In CDP, patient grouper is a function that allows you to view different accounts for the same patient.
True
For organ acquisition accounts, what is the specific document that is usually required to be sent to a payer?
D-4 Cost Report
In the movie “Mean Girls”, what is the group name for Regina, Gretchen, and Karen?
The Plastics
When an AI or Global Analyst determines that additional pricing details are needed to refute a paid correctly denial on a corrected claim, what item type should they select and who should it be assigned to?
A1’s and Global will use Pricing Validation item type under Team: RSG, Category: RSG QA and assign to W/O Senior or Appeal Writer for RSG Exchange QA (See “Exchange Workflows for AI’s and Global” pdf on Sharepoint for details).
In the Resolution Dashboard, which tab do you use to see what workflows have been sent to another department?
Open Exchange Workflows
For DRG Outlier, what is a resource RSG can check to understand what charges were denied on the claim?
The EOB for line-item denials/breakdown. Check client system for a denial letter that might describe the denied charges in detail. Review the client notes for a summary of denied charges.
In the movie “High School Musical”, who are the protagonists and antagonists (3 total)?
Troy Bolton (Zac Efron), Gabriella Montez (Vanessa Anne Hudgens), and Sharpay Evans (Ashley Tisdale)
True or False: When an A2 determines that Provider Rep may be the best next step for an account, they should send a Provider Rep Escalation QA workflow to Client Delivery Lead.
False – AI’s, A2’s and Global should send a Provider Rep Escalation QA item type (located under Team: RSG, Category: Client Delivery Exchange QA) to RSG Senior for RSG Exchange QA. If RSG Senior agrees with recommendation, they will create a Provider Rep – Need to Send item type assigned to Client Delivery Lead.
In the Availity portal, what are some features that are useful for follow-up? Please provide at least 2.
Verify eligibility, claim status check, submit appeals, send direct messages to the payer, & live chat function