Resolving Denials

Question 1

What are follow up workqueues?

Answer 1

A list of outstanding claims that need follow up; a list of claims that have been denied.

Question 2

If a claim cannot be resubmitted to the payor for payment, which activity can we use to pass the balance on to the secondary insurance/guarantor?

Answer 2

NRP (next responsible party) * Actions

Question 3

After performing the NRP activity, what do you need to do to remove the claim from your workqueue

Answer 3

no need to do anything the system auto completes

Question 4

What does the demand claims functionality do?

Answer 4

Creates claims real time, removes charges from the automatic claims process, bypasses edit checks in the CDF

Question 5

Claim denials that should be reviewed are caught by the system and placed in which type of workqueues?

Answer 5

follow-up

Question 6

If a claim must be printed to paper right now, the (demand claim/resubmit claim) should be used?

Answer 6

demand claim

Question 7

If, in order to resubmit the claim successfully, information on the charge needs to be updated, the ? function should be used?

Answer 7

correct

Question 8

If a denial cannot be corrected, how can you move the balance to the next payor or guarantor?

Answer 8

Next responsible party (nrp)