Standard Work

If ATV/Medcompass is not updated with a Third-Party Authorization and the claim was routed to rework due to a call......

• Return to the CSR or Appeal Analyst

• Remove the claim from my route list.

• Processors will do an 839 and not return to the CSR for an update.

• Send the claim to another processor.

Provider Deviations are found.......

• In Epolicies

• On the NRT website

• Asking another processor for the answer

• In Standard Work

Turn around time for a call is.......

• 5 days

• 10 days

• 3 days

• 4 days

Can we do an 839 on a Network Escalation request?

• Yes

• No

After you do an 839, what route reason do you use to route the claim to yourself?

• 599

• 510

• 500

• 501

Where do we look for a Precertification?

• ATV

• Medcompass

• Claim history

• ATV/Medcompass

Provider called and states they disagree with the denial on the claim. Claim is denied per SIU. Can you rework the claim?

• Yes

• No

When returning a misdirected claim to the CSR with Reason code 510. Do you have to use a rework return reason?

• Yes

• No

Who are the Inventory Managers?

• Kim

• Anne

• Kim/Kara

• Kara

How do you determine if there is more than one segment to your claim?

• You don't have to check

• Check CQC

• Ask SME

• Ask a Supervisor