Retroadjudication Flashcards
What is the difference between the patient filing order and the visit filing order?
A visit filing order is the order in which the applicable coverages will be liable for the balances incurred during a visit. A single visit can have different filing order from the patient’s previously defined filing order
True or False: Every visit affected by retroactive coverage change is sent to a WQF for review
False, the system can automatically retroadjucate visits or automatically reject retroadjucation for visits. When the system automatically accepts or rejects the coverage change, the visit does not get routed to a WQF.
you can choose this via the VFO profile
What happens to the visit filing order when you reject retro for a visit, either automatically in the profile for manually from a WQF?
The visit retains the original filing order
What happens to the visiting filing order when you accept retroadjuctation for a visit, either automatically from the profile or manually from the WQF?
The visit is retroadjucated, updating the filing order for the visit. If the primary coverage changed then the charges from that visit will also be voided and reposted.
When set with foundation system settings, what will happen to self-pay payments that were associated with a charge voided and reposted after Retro?
Will be reapplied.
