DME me please!
I'm a type of DME supply that mothers order when pregnant.
Breast Pump
What does the acronym CAMS stand for?
Consumer Account Management System (CAMS).
You are reconsidering an INN claim in UNET. The claim only has one service line which has billed charges going towards the deductible. The claim originally processed with a NI remark code. Thee system is not inputting a remark code automatically. Which remark code will go on your service line? Which remark code will go on your claim level line?
W1 remark code on your service line and 22 on your claim level line
True or False..
The Alt +F11 macro will help you "dummy" up a claim. pick up a penny line/70 line, pick up a 74 line and backs out the claim?
False
True or False...
The time frame for a member to file an appeal/grievance starts from the date the payment is received by the doctor/facility?
False. The time frames start the date the claim was processed
What does the acronym DME stand for?
Durable Medical Equipment
What are the three types of financial accounts that a member could have?
How should you handle a G81 claim level reason code that is systematically applied to the control line when you are adjusting a claim?
Leave it per prompt pay guidelines
This macro will help adjust a zero-paid denied and underpayment claim?
Ctrl + A
Lauren wants her husband John (not a dependent on account)to be her authorized representative on her account. What resource do you use to help Lauren with this request?
EZCOMM
When a member needs diabetic shoes, who would you refer them to?
(Hint: National DME providers SharePoint)
Linkia (Hanger)
What is your primary resource/advocacy for support when using CAMS?
Financial Advocacy
What is the default recon code if Preference does not have one listed?
22
What is the macro for inserting a "30 line"?
Alt + F5
True or False...
A member calls in about a claim that was denied for Workers Compensation (remark: L7). The member states that this was not due to Workers Comp, can you take this information over the phone and reconsider the denied claim?
(hint: claims advocacy)
True
Outside of the National DME providers sharepoint, what site can you refer the member to for a breast pump?
optum store website
(CAMS) In the Member Claim History screen, what are three fields that you will see?
If you are adjusting a claim that went to the deductible and processed with a UG. because the claim was actually preventive and you are not paying 100%, what remark code will be at the service line level when you MPP the new processing?
remark code UG
What is the macro for changing line level cause codes?
Ctrl + Shift + =
Is CPT code 80061 considered routine per HCR guidelines for a 42 year old male if billed with diagnosis codes z12.220 and E78.79?
NO this would not be considered routine b/c there is a lipid disorder present on the claim.
Per the National DME providers SharePoint, if a member needs a high end specialty hospital bed, what DME company would you refer the member to?
Ethos Therapy Solutions
In iset, iplan 7 indicates what type of financial account?
HSA w/ Optum bank
What are the 3 "filler codes" when it come to remark code versus recon codes and when are they used?
D1- INN professional
D2- INN Facility
VW-Everything else
What is the macro for locating original iCES remark codes?
Ctrl + Shift + L
Robert and Mary are still together and Robert has now turned 65 and is on Medicare, Mary has also retired now but is only 63 with no other insurance other than her own UHC plan and Roberts retiree plan.
1. Who is the primary insurance for Robert?
2. Who is the primary Insurance for Mary?
Robert: Medicare
Mary: UHC