Steps to foIIow wIth the AVP (Automated VoIce Pesponse) System :

CaII the approprIate phone number for the Insurance company.

f the number Is unreachable, make a note of It.

f It reaches an A7F, lIsten the entIre optIons lIsted by the A7F carefully.

Select the most approprIate optIon to check elIgIbIlIty, claIms or other Info, as
requIred.

For aII hedIcare carrIers, cIaIm status shouId be checked onIy through the AVP.

|ost A7F systems wIll fIrst ask for the Tax 0# or provIder#, enter the requIred.

f the provIder# has alphabetIcal characters, enter the optIon to get the help from the
A7F on how to enter alpha characters and enter accordIngly.

The patIent's 0# mIght also have alpha characters, In thIs case follow the A7F
InstructIons and enter the 0# carefully.

Numbers shouId be entered very carefuIIy, mIssIng or enterIng a wrong number
wIII gIve an Incorrect resuIt.

n the same manner, for claIm status verIfIcatIon, enter the 0DS when prompted.

The date format should be taken Into consIderatIon here. Some A7F systems stIll
follow the 'mmddyyyy' format. n such cases, the 0DS should be entered as requIred.

For example : If the 0DS In our system Is '01010J', the date In 'mmddyyyy' format Is
'0101200J'.

Usage of * and # sIgns has sIgnIfIcance wIth AVP caIIs. These sIgns shouId not be
Ignored when prompted for.

Some A7F systems wIll lIst the number of claIms for a specIfIc 0DS, on fIle. n such
cases, the status of all the avaIlable claIms for that 0DS should be lIstened fIrst and
then, notes for the most relevant claIm should be entered.

In generaI, AVP of dIfferent carrIers dIffer In theIr own steps. Therefore, IIstenIng
the AVP InstructIons carefuIIy Is vItaI and wouId defInIteIy yIeId good resuIts, If
foIIowed as Instructed.
Steps to foIIow whIIe on conversatIon wIth Insurance PepresentatIves :

CaII the approprIate phone number for the Insurance company.

f the number Is unreachable, make a note of It.

f It reaches an A7F, lIsten the entIre optIons lIsted by the A7F carefully.

Select the most approprIate optIon to reach a representatIve for verIfyIng elIgIbIlIty,
claIms or other Info, as requIred.

For aII hedIcare carrIers, cIaIm status shouId be checked onIy through the AVP.
DnIy denIaIs and other Issues shouId be verIfIed wIth the rep.

SeIf-IntroductIon :

When an Insurance rep comes on the lIne, greet hIm/her accordIngly and Introduce
yourself as a representatIve of the provIder's bIllIng offIce, gIvIng your Pseudo name.

Tell her the reason for your call.

For example : "Cood |ornIng |a'm/SIr, my name Is KevIn, 'm callIng from 0r XYZ's
bIllIng offIce. 'd lIke to check claIm status/elIgIbIlIty for a patIent".

As a common procedure for provIder verIfIcatIon, the Insurance carrIer rep wIII
fIrst request for the Tax I0# or the prov#, In order to reveaI any InformatIon.
The requested Info shouId be gIven to prove that the caII Is an authentIcated one.

VerIfyIng eIIgIbIIIty :

f you are verIfyIng elIgIbIlIty, the rep wIll ask for the patIent's 0#, name and 0D8
(0ate Df 8Irth). SometImes, the rep mIght even ask for the group# or plan#. ThIs Info
should be provIded to help the rep locate the patIent's fIle.

Dnce the Insurance rep locates the patIent's fIle, get the patIent's coverage effectIve
date and verIfy the patIent's current elIgIbIlIty.

f the patIent's coverage Is termInated, get the termInatIon date.

7erIfy If the Insurance carrIer acts as prImary or secondary for the coverage perIod.

Ask If they have any other Insurance coverage Info for the patIent.

Cet the correct claIms maIlIng address, fIlIng lImIt and processIng tIme for the claIms,
the dIrect phone# to contact the correspondIng customer servIce center to check
claIms and other related Info.

VerIfyIng cIaIm status :

f you are verIfyIng claIms status, the rep wIll ask for the patIent' s 0# and name.

Dnce, the Insurance rep locates the patIent' s fIle, he/she wIll ask for the 0DS (0ate
Df ServIce) and the total bIlled amount. Even the 0r' s name on the claIm may be
requIred for thIs purpose.

For paId claIms :

f the rep says that the claIm Is paId, get the paId amount, check#, check date, the
bulk amount of the check and the maIlIng address of the check. Ask If the check was
cashed and If so, get the cashed date.

f the check was Issued to an Incorrect address, InquIre why the check was sent to that
address and ask the rep to verIfy the address, they have for the provIder. Then, ask
the rep to make a stop payment on the check and reIssue a new one to the correct
address.

f the check was Issued to the correct address, but If we have not receIved any ED8
(ExplanatIon Df 8enefIts), ask the rep to send us a copy of the check and duplIcate
ED8. Try to get It faxed or maIled to us at the earlIest.

For unpaId claIms :

f the rep says that the claIm Is denIed, get the exact denIal reason. f the claIm can
be adjusted and sent for a reprocess, over the phone, get It done. Cet the claIm
control# for our reference, whIch would help In future followups.

f the rep says that the claIm Is pendIng or suspended for more Info, get the actual
Info they need to get the claIm processed.

f the claIm needs to be corrected and refIled wIth any addItIonal Info, get all the
detaIls of the Info they need, to get the claIm reprocessed for payment. 7erIfy If they
have a dIfferent revIew or appeal address to submIt the refIled claIm.

For claIms not on fIle :

f the rep says that the claIm Is not on fIle, verIfy If theIr claIms maIlIng address
matches wIth the one In our records. f It dIffers, note down the correct maIlIng
address and get the fIlIng lImIt and processIng tIme for the claIms. Ask If the claIm can
be faxed and If so, get the fax# and name or dept, to whom the claIm should be faxed.