Following up on outstanding claims Flashcards
Define a follow up Workqeue
a list of outstanding claims
How can you identify the responsible payor?
Highlighted in yellow in f/u wq assistant
Where can you find the payor contact information for a claim in your workqueue?
Insurance coverage section
Which activity do you perform when the payor did not receive the claim and you need to send them a new claim?
Resubmit claim
Which activity do you perform when you want to summarize all of the actions taken while working on a claim?
Note
Which activity do you perform when you can’t work the claim right now so it shouldn’t be on your active tab?
Defer
How do you prioritize your wq to work the claims with the oldest service dates first?
Click the svc date column heading
Where can you view the past activities performed on claims?
Activity History in the assistant; follow-up activities section in the wq information display
After calling a payor about an outstanding claim, you want to document the conversation so that others researching the balance see a record of your work. Which activity or activities would you add?
Call payor and note
Explain the difference between selecting resubmit claim and resubmit selected.
Resubmit claim sends the entire claim back to the claims queue; the system will determine which charges need to go on the resubmitted claim based on the payor’s needs. Resubmit selected allows you to choose which charges from the claim will go back to the claims queue and be resubmitted to the payor
What is the consequence of deferring a claim, and under what circumstances might you do so?
Defer moves the claim off your active tab (work list) and sends it to the User Deferred tab. You would do this if you were prevented from working on a claim for a certain period. For example, if the payor said to expect payment in a week, you don’t want to work on that claim until a week has passed and you again check for a payment.
