Claims Ops 1 Jeopardy Template

IPAT	Provider Selection	Timely Filing	BONUS
100 What is Explanation (EX) code 034 Claim Level bypass Auth Override code if claim is receiving the UMAE warning message	100 What is DBMR Title of the return note from DBM	100 What is 180 calendar days Claim submission filing limits for Participating providers unless contract lists a longer exception	100 What is acceptable Proof of timely Filing * Letter or Appeal * Handwritten Document * POTF showing an original submission without timely submission This is listed in Step 2 of the SOP as...
200 What is 025 - DOS matched Appropriate EX code after you select the line item to apply the authorization to from the drop-down box that corresponds with the matching DOS of the authorization	200 What is INCF Incorrect Claim Form Warning error received when the current provider selected should not be selected	200 False Medicare: Providers must submit within three years from the paid date of the EOB or the date on the letter. True or False Medicare: Providers must submit within 90 calendar days from the paid date of the EOB or the date on the letter	200 What is Alt + Shift + D This macro Prompts for two dates and determines timely filing and inpatient stay days
300 What is Review the authorization in ICUE First thing you should do if claim is returning the IPBL with the UMRV warning message	300 What is Place of service address This is a required match when multiple provider have the same billing/remit address	300 What are maternity, inpatient, hospice, skilled nursing facility types of claims. These types of claims, when billing a date range cannot be split	300 What is UMAE Authorization requirement may be waived for this Service This warning message instructs processors to either Apply Bypass Preauth Edit with EX code 034 at claim level or Apply Pre-Auth Not Required with EX code 036 at line level followed by reviewing each line for H30.
400 What is DS status Match UM Authorization should be in this status if you are Refer to the Emergency Billed SOP for processing	400 What are •Change the provider ID to UNKNOWN in the Provider ID field. •Add a claim note stating provider is not on file. •Pend the claim in Facets CSP to DBMP. These are the steps when a matching group is not found...	400 What is XX7 Providers submit claims with this Type of Bill Frequency to be considered a corrected claim	400 False An authorization line with place of service (POS) 21 and 9999 units CANNOT be matched to a hospital claim. True or False An authorization line with place of service (POS) 21 and 9999 units can be matched to a hospital claim.
500 What is 1.00 Appropriate number for Value Code 80 if the From and Through date is the same	500 What is INPS warning message This warning message appears on any claim where a 5XX group record is selected	500 What is Universal EDI acceptance code A1:19 This 4 digit Universal EDI code is listed on an Electronic claims Clearinghouse Acknowledgement Report when claim is accepted	500 What is FLFHK ( Healthy Kids) Under this FL Group Plan, Baby's claim can be billed and processed under the mother's member ID for 3 days after the baby's DOB.

Claims Ops

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