Issue Types
I am writing in to appeal D2740 and D2950. It was denied with EOB code ANM and ASJ. Please reconsider for payment.
What is an appeal
In ETS, the Product dropdown should display what for Medicare cases?
What is Medicare Complete?
RMO (Regionial Mail Operations) indicates that the correspondence was received from where?
What is HOV?
Select this option for Letter Type when creating an acknowledgement letter.
What is ack?
Kai lives in Texas. She pulls a piece of inventory that is CA DCDC. How should Kai process the request?
What is reassign work? -
I received a letter in the mail advising that my appeal was upheld. Can you please send me the documents that were used to uphold my appeal?
What is an ERISA Document Request?
True or False: All Medicare providers are required to submit an authorization form in order to appeal on behalf of the member.
What is False? - Only OON Medicare providers are required.
The Intake Record Number for Fax & Email is this.
What is 16 9's?
Kai is working on an appeal that was submitted by the member. Who is the letter recipient?
What is member?
Kai is working on a claim that is in an 11 status. How should Kai proceed?
What is SME LOg? -
Dr. Paul Marvey is advising that I get implants. I don't think that I should. Can you please clarify what my benefits are for implants?
What is an Inquiry?
Medicare Requests that come from customer service should be handled how?
What is "Route the request back to customer service."
This number should be used when entering the Group Number for Cirrus Polaris plans (parent group 10093)
What is the Policy Number?
True or False: Only Dental & Vision must be selected when creating letters.
What is False? Both Dental, Dental & Vision must be selected.
True or False: When creating an ack letter for Transamerica and Stonebridge groups (LOB 0246/0237), the state of governance should be used.
What is False? -
I just received the EOB for the services I had done on 2/17/2025. You denied them all and I disagree with this. I want to formally request an external appeal and have a clinical person look into this.
What is an ERO/IRO Request?
True or False: Medicare cases require an ack letter to be created.
What is False? Medicare cases do not get ack letters.
True or False: The Tax ID can be verified using ISET/ACET.
What is False? - Only FACETS should be used to verify the Tax ID.
Kai is sending an ack letter to the member who filed a written appeal governed by the state of Texas. Which template should she use?
What is A_SB_TX_ACK2 ?
CEU_ACK_LETTERS > SPECIALTY_BENEFITS > Specialty_Benefits_Non_Private_Label > A_SB_TX_ACK2
True or False: Kai receives a DOI request and determines it is not from regulatory affairs, therefore, she should enter a case.
What is False? -
Not from Regulatory Affairs
I went to the dentist to have an extraction. When I received my EOB, I noticed I was being charged for a cleaning which I never had. I also noticed that my jaw is extremely sore and my gums are starting to show signs of infection. Please help me get my money back.
What is a QOC & QOS Complaint?
Dr. Walker is not a participating provider. He is appealing the $27.00 that we paid on the D2740. Dr. Walker explains the fee should be $56. Should we open an appeal for Dr. Walker?
What is yes? - Even though Dr. Walker is OON, he is appealing the contracted fee that was paid.
Submitted on Behalf Of should be this for par and non par providers who are disputing overpayment requests.
What is Provider?
Kai is sending an ack letter to the provider. The appeal is governed by the state of FL. The situs state is TX. The LOB is 0200. What template should she use?
What is A_SB_PAOStd ? CEU_ACK_LETTERS > SPECIALTY_BENEFITS > Specialty_Benefits_Non_Private_Label > A_SB_PAOStd
Kai is working in the fax box and receives a W-9. What should she do?
what is email Cabral, Cecilio Karlos and Cc her supervisor.