PCC Ticketing Tips - Get Paid

Created by Lynn Shoop, Modified on Wed, May 13 at 2:29 PM by Lynn Shoop

Claims:

Possible Issues	Essential Info from PedsOne	Helpful Info from PedsOne	Other Considerations
Rejections	Patient PCC# and DOS
Status (did it go out?)	Patient PCC# and DOS
Denial	Patient PCC# and DOS	EOB from payer or ERA Ck #	Clearinghouses want a payer ref#, phone# and name of rep spoken to before they will pursue any denials
Dropping to Paper	patient pcc# and DOS
ECS config issues (NPI, taxonomy, etc)	patient pcc# and DOS; insurance plan name from 'Insurance Plans' table in the EHR. - Configuration dropdown menu - Tables - Insurance plans from the dropdown
HCFA config issues (NPI, taxonomy, etc)	patient pcc# and DOS; insurance plan name from 'Insurance Plans' table in the EHR. - Configuration dropdown menu - Tables - Insurance plans from the dropdown	scan of HCFA as printed noting updates needed - redact PHI before sending	printing a HCFA is not a reliable check of the electronic config - they are 2 separate set ups and often HCFAs aren't fully updated/synced to the electronic config
new Insurance plan config	scan of patient card - front & back

ERA/835:

Possible Issues	Essential Info from PedsOne	Helpful Info from PedsOne	Other Considerations
Missing	Deposit date, Check #, Amount		Must be 3 full business days from date of deposit in order to open a case with the payer
Missing - UHC Specific (UMR, Oxford, Golden Rule, All Savers, Student Resources, Medica, UHC Community)	Optum requires a copy of a downloaded ERA from their portal in order to open a case to have them research why it didn't deliver
Enrollment	Insurance Plan Name from the 'Insurance Plans' table in the EHR. - Configuration dropdown menu - Tables - Insurance plans from the dropdown If EFT's are depositing, a recent check number, deposit date and amount is needed.		PCC MUST INITIATE ALL ERA ENROLLMENTS IN ORDER TO PROPERLY LINK TO THEIR CHANNELS

Eligibility:

Possible Issues	Essential Info from PedsOne	Helpful Info from PedsOne	Other Considerations
New elig connection request	Insurance plan name from the 'Insurance Plans' table in the EHR. - Configuration dropdown menu - Tables - Insurance plans from the dropdown	Patient PCC# and scan of card	Not all payers and/or clearinghouses support elig. PCC will check all their connections for supported elig. It is always worth asking PCC.
Not Working	exact error and code # from EHR and Patient PCC#

EFT:

Possible Issues	Essential Info from PedsOne	Helpful Info from PedsOne	Other Considerations
Setup	N/A	N/A	Caution should be taken by the practice or P! when setting up EFT to ensure EFT ONLY option is selected; there are often broken ERA connections when this isn't selected, which requires a brand new ERA Enrollment