Check Details
Who issues checks?
The Adjuster
EMC applies to what state?
Florida
Who requests a patient to get an IME?
The Adjuster.
What does 3rd party mean?
The patient is usually NOT a USAA policy holder.
Timely Filing applies to what states?
New York and Florida
Where can we find the check or transaction number for a bill that was paid?
The annotations.
If EMC is established, the coverage limits increase to how much?
$10,000.
What code will we see on an EOR if the bill denied based on an IME?
BIME
How can we tell if a 3rd party claim is open?
If the 3rd party claim comes up, you can assume it is open.
Florida bills must be submitted within how many calendar days?
35
Where would the doc id be located on the check?
The bottom/middle of the check near the signature line.
Who can make an EMC diagnosis?
Only a Medical Doctor (MD), an Osteopathic Physician (DO), Dentist (DDS) or advanced RN Practitioner can make the EMC diagnosis.
What tab would we use to see if the patient has any negative IME's on file?
The admin tab
No. We advise the caller to contact the patient.
New York bills must be submitted within how many calendar days?
45
If a caller asks us if the check was cashed or cleared, what do we do?
Refer the caller to the adjuster.
In medflow, what tab would we use to see if EMC documentation has been received?
Admin Tab
If the provider disagrees with the IME denial, what can they do?
They have 90 days from the effective date of the IME to appeal the exam/ termination.
If the 3rd party bill is NOT on file, what do we do?
Advise the caller to submit the bill. You may give them the 3rd Party Fax/ Mailing Address.
Can we send bills that have denied for timely filing to recon?
No
If a caller has a check with no patient name or other helpful information, this is most likely what kind of check?
A 3rd party check. Please advise the caller to contact USAA directly.
Is there an official EMC form that providers have to fill out?
No. here is no official "EMC Form" that providers can fill out (although some do create their own). EMC is simply determined based on the severity of the patient's injuries noted in the medical records/ bills.
Can we fax out copies of the IME report?
No. The provider must get a copy of the IME report from the patient or their attorney.
If the bill IS on file, what do we do?
Refer callers to the patient because any settlement issued will be sent directly to the patient/patient's attorney.
If a provider has sent in proof of timely filing in and we found the proof on the patient's claim, what do we do?
Advise the caller that we'll need to contact the adjuster.