Providence_Commercial

Which SBO code is used for Date of Birth discrepancies?

• 45143

• 45170

• 45152

• 59867

How many days should be allowed for a first-level appeal tagged account (excluding underpayment scenarios)?

• 30 days

• 60 days

• 90 days

• 120 days

What T-code should be utilized when exceeding the patient billing Timely Filing Limit (TFL)?

• 208612 Timely Billing Adjustment

• 208613 Timely Billing Customer Service Adjustment

• Effort Exhausted T-code

• None of the above

Which exception requires routing to the Nurse Auditor, regardless of whether it was an outpatient (OP) or inpatient (IP) stay?

• Account Activity 791

• Utilization Review BDC 106

• Trauma activation with CPT G0390 and rev codes 681 - 684

• Trauma activation with CPT G0391 and rev codes 671 - 684

What T-code is used for adjusting an ED downgrade when the first-level appeal is upheld?

• 208613

• 45143

• 3052

• 555

What does the note "Letter: PYR - LETTER printed" indicate in the context of appeal follow-up?

• The appeal has been saved but not yet sent.

• The appeal has been rejected by the payer.

• The appeal has been printed and sent out to the payer.

• The appeal requires further review before sending.

What is the time frame for reconsideration and appeal under the Oregon Health Plan (OHP)?

• 120 days

• 150 days

• 180 days

• 210 days

What should be done if a CPT contains a GZ modifier?

• Adjust with Tcode - 20855 after transferring the respective patient responsibility (and ensure a denied EOB is available)

• Adjust with Tcode - 208555 after transferring the respective patient responsibility (and ensure a denied EOB is available)

• Adjust with Tcode - 2055 after transferring the respective patient responsibility (and ensure a denied EOB is available)

• Adjust with Tcode - 8555 after transferring the respective patient responsibility (and ensure a denied EOB is available)

What is the Outpatient Epic Account Activity code used for routing to the DR UM Dept./Utilization Review?

• 555

• 208613

• 791

• 3052

What BDC code is utilized for Nurse Auditor Review in the Inpatient Epic Account Activity?

• 118

• 106

• 451

• 555