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Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept...

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Page 1: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 2: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 3: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Martin Dept level acct wqs

Page 4: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 5: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Martin Bus Off Account WQs

Page 6: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 7: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 8: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 9: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete
Page 10: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Martin Account WQs Each PAR has their own Account WQs for

following:

– Insurance Followup

– Consecutive Accounts

– Correspondence

– Coverage Updates (groups)

– Credit Balance – both ins and self pay

– Denials

– DNBs and Stop Bills

– Late Charges

Page 11: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Martin System Auto Actions

Page 12: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Martin Claim Edits – to the dept

ADT/Registration Related

– Missing Auths – as defined by claim def

– Incomplete Fields

– Incomplete MSP form

– Newborn Medicaid check – is the coverage

linked the baby’s and not mom’s?

Page 13: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Martin Claim Edits – to the dept

Revenue Integrity and HIM

– Infusion CCI edits

– OCE Charge Errors

– Noncovered Services

Page 14: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Charge Review WQs

Extensive Charge Review for Rev Integrity

Page 15: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Other Helpful Epic Setups

Cosmetic and Insurance Combo cases

– “SP” modifier appended to self pay

charges which bypasses insurance claim

buckets and drops into self pay

Manual Use WQs

Page 16: Martin Dept level acct wqs - floridaaaham.starchapter.com · Martin Claim Edits – to the dept ADT/Registration Related –Missing Auths – as defined by claim def –Incomplete

Questions?


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