Question 1

What is arbitration?

Accepted Answer

a hearing, in which a neutral third party, called an arbitrator, hears the dispute between the doctor and the insurance company and decides whether or not the claim should have been paid. Your doctor's attorney and the representatives from the insurance company will present arguments before the arbitrator. The arbitrator has 30 days to issue a decision, called an “award.”

Answer

a hearing, in which there is a dispute between the doctor and the insurance company on whether or not the claim should have been paid.

Answer

a hearing, in which a neutral third party, called an arbitrator, hears the dispute between the doctor and the insurance company and decides whether or not the claim should have been paid. Your doctor's attorney and the representatives from the insurance company will present arguments before the arbitrator. The arbitrator has 15 days to issue a decision, called an “award.”

Question 2

What are the reasons why we would send a claim to arbitration?

Accepted Answer

IME cut off, peer review, misrepresentation, w35 remit code R1, any claim with no status from the carrier after 3 attempts, etc

Answer

request for additional records, peer review, treatment not related to injury

Answer

missing anesthesia records, missing primary eob, no authorization

Question 3

What does AOB stands for?

Accepted Answer

Assignment of Benefits

Question 4

What does EOB stands for?

Accepted Answer

Explanation of Benefits

Question 5

When do we work on the work description “Print for Arbitration”?

Accepted Answer

On the 1st and the 15th of each month

Answer

on the 15th of each month

Answer

on the 1st or the 15th of each month

Answer

on the 1st and the 30th of each month

Answer

on the 1st of each month

Question 6

Which are the providers that require a minimum balance to send to arbitration?

Accepted Answer

Innovative Medical, DK Pain Medicine, Downtown Physicians

Answer

DK Pain Medicine, Total Care, Total Anesthesia

Answer

Sedation Vacation, Igor Amigud, Innovative Medical

Question 7

Arrange in proper order the steps we need to follow to print for arbitration?

Question 8

What are the documents required to print for arbitration?

Question 9

What do we do if we have an American transit case denied due to missing documents?

Accepted Answer

Claims can be submitted for arbitration if the bill is delayed or denied and the documents are missing or inaccessible after submitting a reconsideration request that the documents are not in our possession.

Question 10

When do we submit a claim to WC Collections?

Accepted Answer

When a WC claim is denied for coverage, or is not paid in full based on the medical treatment guidelines/fee schedule.

Question 11

What are the required documents when working on a WC Collections case?

Accepted Answer

Bil, medical records, EOB, and ensure every claim has either a WCB number, claim number or both

Question 12

What do we do when handling the work description“Follow up on status of submitted arbitration?

Accepted Answer

We either check a website, a spreadsheet or send an email to obtain the status

Answer

We check the spreadsheet only

Answer

we check the web or call the attorney

Question 13

What do we do if we are unable to locate a patient when working on Arbitration case status for total anesthesia?

Accepted Answer

Apply f/u "escalate to account rep"

Answer

add to bulk

Answer

Request to the TL to remove the claim

Answer

Apply f/u "Needs to be sent for arbitration"

Question 14

What do we do if we are working on arbitration case status for Sedation and the status is case dismissed by arbitrator?

Accepted Answer

Print copy of snip , Attach to the claim, add Notes and Post W43.

Answer

Print copy of snip , Attach to the claim, add Notes and Post W24

Answer

Add claim notes and apply f/u "Escalate to Account Rep"

Question 15

What do we do if we are working on arbitration case status for Sedation and the status is case open?

Accepted Answer

If they are missing a document, print and upload the requested document

Once documents are uploaded apply follow-up "Arbitration case in process" - 60 days. if the case is simply open with no status, and no missing documents: If it is less than 3 months, snooze “Arbitration case in process - 60 days”, if it’s more than 3 months, “Arbitration case in process - 30 days” and send the spreadsheet to Natalie

Answer

If they are missing a document, print and upload the requested document

Once documents are uploaded apply follow-up "Arbitration case in process" - 60 days. if the case is simply open with no status, and no missing documents snooze “Arbitration case in process - 60 days”

Answer

If they are missing a document, snooze “Arbitration case in process - 60 days”. if the case is simply open with no status, and no missing documents: snooze “Arbitration case in process - 30 days” and send the spreadsheet to Natalie

Question 16

We do not leave claim notes on each case we work.

Accepted Answer

false

Answer

true

Question 17

We work on “Print for Arbitration” every day.

Accepted Answer

false

Answer

true

Question 18

If we get a case “Print for Arbitration” or “Needs to be sent for arbitration” on the 21^st of the month, we need to snooze it so it’ll come back to F2 on the 1^st or the 15^th.

Accepted Answer

true

Answer

false

Question 19

It does not matter if we do not have the AOB when printing for arbitration.

Accepted Answer

false

Answer

true

Question 20

In order for a case to be considered complete we need to, either post, apply a follow up, print or request documents via patient or client correspondence

Accepted Answer

true

Answer

false

Question 21

When printing for arbitration I do not need to check the documents that come up in the printing screen.

Accepted Answer

false

Answer

true

Question 22

If submitting a case to WC Collections due to no status from the carrier, the EOBis required

Accepted Answer

false

Answer

true

Question 23

In order to print for WC Collections we need to ensure that the document name includes WCB number and claim number.

Accepted Answer

true

Answer

false

Question 24

Claim number is the same as claim ID

Accepted Answer

false

Answer

true

Question 25

If an arbitration status is in litigation phase we need to contact Rifky for clarification

Accepted Answer

false

Answer

true

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