Mailing Portal
When assigning accounts to yourself, what do you assign it under?
SS Assigned Rep
What do all vendors have to do when first arriving and before leaving?
Check in
True or False:
Appeals are always sent certified?
True
What are the 4 PHI we would need to confirm the patients account?
Name
DOB
SSN
Patient Address
We have a claim that is being requested to be faxed and RBA states its been completed. How do we proceed with the paper claim?
Shred it
What is 1 thing that is always needed when mailing attachments to the insurance?
A cover letter
Employee is at the front door and you notice they are trying to swipe their badge and its not working, and they buzz in. What are your next steps?
Let them know on the intercom that Security will be with them.
What are the 2 updates you make to Patcom when working appeals print?
Update PIC2 to APSB and add note.
We have 4 PHI: Patient's DOB, address, and SSN are all correct, but the patient's name is misspelled. What is our next step?
Update status to AA call back.
What do we do if there are no attachments in the RBA?
Review Patcom note to see if 1. attachments are needed or 2. there is anything special we need to do with the claim.
Name all 4 items that need a cover letter no matter if we are sending to the insurance or the patient.
Medical records, TPL forms, W9s, & LTR letters
An employee comes out to use the bathroom and forgot their badge at their desk and they ask you if you can let them in. What do you?
Put it in the security chat, and you can let them in.
What status do we use after print has been completed?
Pending audit
We confirmed all PHI provided is correct, and we pulled the requested records, but there is an affidavit that needs to be notarized, what status do we update it to?
Notary Needed.
General rule is that we dont send claims certified. What are the exceptions to that rule?
1. if being sent with medical records.
2. TX MCD
3. Requestor specifically requests it.
Itemized Statement and Financial applications always go in what?
Flats
You are at the back door coming in, and there is an employee behind you jogging to the door to try and get in with you. What do you do?
Apologize and let them know that you have to close the door behind you.
There are 2 boxes for the same appeal, what do we do with those boxes?
Label them box 1 of 2 and 2 of 2.
We get a request and the only thing they are asking for us to completed the outstanding balance form, how do we proceed?
We update status to fill and sign. No records needed.
What do you do with IP Medi-CAL /California Mediciad claims?
Sign the bottom
What is the only exception to the rule "All Mailing portal items are sent certified"?
When sending I/S to the patient.
There is a person just standing at the front door and you see they have a delivery; you are unsure who they are or where they are delivering from and they buzz in. What do you do? (2 possible answers)
1. Answer the intercom and ask leading questions like who the delivery is for and where they are from and inform security in chat.
2. Answer the intercom and let them know that security will be with them and inform security in the chat.
What are the 4 main boxes we fill out when printing?
SS Assigned Rep
SS Completed By
SS Completed Date
Cert tracking#
We have a subpoena for records and the request only has the patients name and DOB, we confirmed and they match. How do we proceed?
We can proceed to pull records.
The requestor is asking we send to a specific address, but it does not match what is on the claim. What address do we use?
The address on the portal.