Claims Training
-
If claim is received with no Drivers Name, how would you proceed?
Select the (Driver Not in System) option for sub-batch.
(wrong answers:
Skip the claims.,
Pay the claims,
Gain needed information from the previous/next page,
Deny on paper only for MDI/MDNS)
-
If claim is listed as cancelled in Insight, how would you proceed?
Process and deny claim for SNPM
(wrong answers:
Skip the claim.,
Process and pay.,
Deny for UNS (unauthorized no-show).)
-
If claim was submitted with the incorrect Leg ID# listed, how would you proceed?
Deny on paper for ITI
(wrong answers:
Deny in Insight for ITI.,
Search for the correct Leg ID#.,
Deny on paper for MCN.,
Deny in Insight for MCN.)
-
If you receive the error message "Driver is not valid for the entirety of the trip", what would you deny for?
UAD
(wrong answers:
MDNS,
MDI,
ALD,
CD)
-
If provider has not listed the SETI Decal or License Plate#, what would you deny for?
MLP
(wrong answers:
MPN,
IMT,
MER,
MEN)
-
If the mobility type circled does not match what is listed in Insight, what would you deny the claim for?
IMT
(wrong answers:
MMO,
MCO,
UAV,
SDV)
-
If claim is submitted with "Stretcher" mobility type, what else must be listed on the claim form?
Attendant/Monitor
(wrong answers:
Member Name,
Leg ID#,
Initials,
Provider Comments)