Term
Describe the correspondence sub-process... |
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Definition
The MPP accesses correspondence through the Maxine No Pay/Short Pay Tool.
The MPP will work all actionable correspondence timely. |
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Term
What is the time limit to work your correspondence queue? |
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Definition
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Term
Describe the denials sub-process. . . |
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Definition
| The MPP resolves the denial by researching the date of service, providing requested information and/or taking necessary action steps based on departmental direction for denial reason. |
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Term
What is the time limit to work your correspondence queue? |
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Definition
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Term
Describe the registration denials
sub-process. . . |
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Definition
| The PRC/RRS will research the denial reason and communicate any follow-activities to the PAR/MPP for completion. |
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Term
Describe the daily triage sub-process. . . |
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Definition
Claims are "completed" when the remaining balance can be quickly resolved with an adjustment and transfer.
Claims requiring further research are "passed" and are worked during the collections follow-up process. |
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Term
Describe the Claim Follow-up
sub-process. . . |
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Definition
The MPP takes appropriate progressive collection activity to receive full payment within a reasonable period of time. The MPP follows-up with payor representative and performs required claim follow-up activities. When follow-up action is completed by the MPP, the MPP selects a predefined status code which best describes the action taken and the date worked is automatically recorded in the Maxine No Pay/Short Pay Tool.
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Term
Describe the Generating Secondary/
Tertiary claim pages sub-process. . . |
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Definition
The secondary/tertiary claim page is generated in BORIS Billing once primary collection activities are complete. |
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Term
What is the time limit to work your daily triage queue? |
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Definition
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Term
What is the time limit to work your No Pay/Short Pay queue? |
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Definition
You work each claim in you No Pay/Short Pay Queue within 45 days. |
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