Claims Processing
What claim form is used by hospitals, and what is the name of the form used by individual doctors and practices?
CMS-1450 (UB-04) and HCFA-1500 (CMS 1500)
What is the name of the document required by the VA to show that the claim was first billed to the Veteran's OHI?
EOB/Remittance Advice Report
True or False:
Once a Veteran enrolls in the VA healthcare system, they remain enrolled for life.
True
What is Health Net's phone number?
844-728-1914
What is the PFRAR patterned after?
It is patterned after the standard Medicare Remittance Advice Report
Name 3 out of the five most common rejection reasons.
Duplicate/previously paid claims
Medical Records
Billing/Coding errors
Submit Claim to Contractor
Authorization Errors - Exceeds Visits, Not Authorized, etc.
Name three programs for Veteran's:
Patient Centered Community Care (PC3)
Veteran's Choice Program (VCP)
Veteran's Choice Program Provider Agreements
Traditional Community Care
State Home Per Diem Program
Indian Health Service / Tribal Health Program (IHS/THP) Reimbursement Agreements Program
Community Emergency Medical Care
What program reached an agreement with the VA in October, 2018 to expand its services to all Health Net regions, and to extend their current coverage for one year?
TriWest
What does PFRAR stand for?
Preliminary Fee Remittance Advice Report
How long do you have to file an appeal?
Within one year of the date of the initial determination.
How soon should an ER visit be reported to the VA?
ER hospital admissions should be reported to the VA within 24 hours when possible; notification should not exceed 72 hours.
What phone number are Veteran's advised to call when billed by a provider?
877-881-7618
According to US law, what 3 things related to OHI is the VA unable to pay?
Co-payments, Coinsurance, Deductibles, and any similar payments a veteran may owe a provider as required by their OHI.
Who is able to initiate an appeal?
The provider, the veteran, legal guardian on the Veteran's behalf, or a representative appointed in writing by the veteran or the provider.
True or False?
VA is not required to bill OHI including policies held by a Veteran's spouse for medical care, supplies, and prescriptions provided for treatment of Veteran's non service connected conditions.
False
Which of the following VA Community regulations is defined below?
Non Service Connected Emergency Care: Allows VA to consider claims for emergency treatment, or travel related to a non-service connected condition.
38 U.S.C 1725
Prior to this year's centralization, how many VA processing sites were spread across the five regions?
98
What are the top 5 denial reasons?
Not Timely Filed
Non-Emergent Care
Not Authorized
No Treatment in 24 Months
VA Available
What process is coming out in 2019 which will allow claims with supporting medical documents to be submitted electronically as attachments?
EDI 275 Attachments
What does it mean for a veteran to be service connected?
The Veteran is determined by VA to be disabled by and injury or illness that was incurred or aggravated during active military service.