Reviewing Coverage Changes and Affected Charges Flashcards
VFO (Visit Filing Order)
The order of liability for the charges of a given visit.
What is a PB Har?
1 Encounter = 1 HAR; All encounters with the same visit matching criteria are a single HAR
What is retroadjudication?
the altering of a visit’s filing order.
What happens to the invoice number of a charge that undergoes a void and report?
It is copied to the new charge in the event that a payor responds and references original invoice number.
Retroadjudication is for PB only. What does HB use?
Coverage Manager.
What are the benefits of retroadjudication?
Reduction of Denials, Faster reimbursement, saves user time from voiding and reposting.
Which jobs evaluates all visits affected by retroactive coverage when run?
PB Nighly processing or template1238-Retroadjudication processing.
In Visit Filing Order Review Automation, rules are listed by priority. Once the visit qualifies for a rule, does it keep going to the next rule?
No. Once any action is performed, there is no need for the system to continue against lower priority rules.
Can a visit qualify for multiple retro review WQ?
No because this is a prioritized list.
In a Retro Review WQ, where can you find the current and proposed filing order for a visit?
Coverage summary.
In a Retro Review WQ, where can you see the currently responsible party for a charge?
Charge Details
When will the system automatically void and repost the charges from that visit if you accept a filing order change?
Whenever the primary coverage changes.
If you see a status of “J” in Prof Visit Inquiry, what does this mean?
Visit has been retroadjudicated
If you see a status of “j” in Prof Visit inquiry, what does this mean?
Visit is pending retroadjudication (in a retro review WQ)
In Prof Tx Inquiry, if you see the status “retro” what does it mean?
Charge was voided and reposted due to retroadjudication.
