WCR To PR26/27 (Day 5)

Question 1

Worker Compensation Reserve

Answer 1

If a person mets with an accident or gets diagnosed with any disease while working hours, in such condition Worker Compensation Reserve will cover the risk.

Question 2

COBRA (Consolidated Omnibus Budget Reconciliation Act)

Answer 2

If a person is jobless or ex-employee and he doesn’t have any insurance plan, in such case if he gets diagnosed with any disease, in such condition as per COBRA Act, his previous organization will cover the risks for 18-36 months.

Question 3

Medicare Supplementary Plan

Answer 3

The leftover amount of Medicare Part A,B & D will be covered under Medicare Supplementary Plan.

Question 4

How will you handle a “Claim Denied for Coverage Terminated” case?

Answer 4

I would handle a “Claim Denied for Coverage Terminated” case by first asking the denial date from the insurance representative. Then, I would inquire about the start and end dates of the policy. If the policy is active, I’d request the representative to reprocess the claim and gather information such as the TAT period, claim number, and reference number. My final action would be follow up after the TAT period.

If the policy is inactive, I’d inquire whether there’s an active insurance policy for the patient. If yes, I’d ask for details about the active policy, including claim number and reference. My final action would be to forward this information to the EVBV department.

If there’s no active policy, I’d request the claim number and reference number from the representative, and my final step would be to bill the patient.

Question 5

Call Opening Procedure

Answer 5

Hello, this is Franklin (pseudo name) calling from Provider’s Office checking for Claim Status.

Question 6

Call Hold Procedure

Answer 6

Can I please put you on hold for a minute?

Question 7

Hold Release Procedure

Answer 7

Thank you for being online!

Question 8

Call Closing Procedure

Answer 8

Thank you for your assistance!