MOCK-CALL_PAID_SCENARIO
CLAIM PAID
ETHAN is an AR CALLER calling an Insurance rep named EMILY for a claim paid status
Emily: Thanks for calling this is Emily how may I help you today?
Ethan: Hai my name is Ethan I am calling from the doctor’s office and would like to check the claim status for a patient.
Emily: Which doctor’s office you are calling for?
Ethan: I am calling for Super Cardiologist Associates
Emily: And what is your telephone number?
Ethan: My telephone number is 1800-999-9999
Emily: What is the provider’s tax id number?
Ethan: The provider’s Tax ID number is 123-456-789
Emily: What is the Patient’s member id?
Ethan: The Patient’s member id is U552211
Emily: Could you please hold for a moment so that I will pull up the patient’s records
Ethan: Yes, please
Emily: What is the Patient’s name and Date of birth?
Ethan: The patient’s name is Linda Far and her date of birth is 26/11/1995
Emily: What is the date of service you checking for?
Ethan: The date of service is 3/2/2022
Emily: What is the billed amount on this claim?
Ethan: The billed amount is $1200.00.
Emily: Could you please hold for a moment so that I will search for the claim?
Ethan: Yes Emily take your time!
Emily: Thanks for being on hold Ethan, the claim has been processed and paid already!
Ethan: May I know the claim received date?
Emily: Claim was received on 3/16/2022.
Ethan: May I know the claim processed date?
Emily: Claim was processed on 3/20/2022
Ethan: And what is the paid date, Emily?
Emily: Claim was paid on 3/25/2022
Ethan: May I know the allowed amount?
Emily: The allowed amount is $100
Ethan: May I know the paid amount?
Emily: The paid amount is $75
Ethan: Is there any patient responsibility?
Emily: Yes the patient’s responsibility is $25 copay
Ethan: and the remaining $50 in the billed amount is for?
Emily: The remaining portion on this claim is provider write-off or contractual adjustment
Ethan: Ok thanks for this information Emily
Emily: You are welcome
Ethan: Emily was it paid through check or eft?
Emily: It was paid through a paper check
Ethan: What is the check number?
Emily: The check number is 12345678
Ethan: Is the check single or bulk?
Emily: It is bulk for the amount of $1000
Ethan: What is the check date?
Emily: The check was issued on 3/30/2022
Ethan: Could you please provide me the check paid to which address?
Emily: Yes Ethan it was issued to the address P O BOX 86592 Belfast Maine 25833
Ethan: Thanks Emily I verified and found the address was correct and do you have the cash date?
Emily: Yes the check cash date was 4/10/2022
Ethan: Thanks could you please provide me the E o b Through our Fax?
Emily: Yes may I have your fax number?
Ethan: Thanks Emily the Fax number is 842-543-6789 and you can put attention to my name Ethan
Emily: Ethan the fax request has been submitted and it will receive within a day
Ethan: Thanks Emily what is the claim number?
Emily: The claim number is A213456
Ethan: And what is the call reference number?
Emily: The call reference is my name and today’s date
Ethan: Thank you so much Emily you are very helpful to me today and you have a nice day
Emily: Thanks Ethan and it’s a pleasure talking to you have a good day
Nicholas: If the paid amount + patient responsibility is not equal to the allowed amount?
Now What would you do and what would you ask a rep?
Ethan: May I know the allowed amount?
Emily: The allowed amount is $100
Ethan: May I know the paid amount?
Emily: The paid amount is $75
Ethan: Is there any patient responsibility?
Emily: Yes the patient’s responsibility is a $15 copay
Ethan: Emily by calculating the paid amount and patient responsibility which is not equal to the claim allowed amount, could you please check the payment information one more time?
Emily: Yes Ethan let me check
Ethan: Ok Emily
Emily: Yes Ethan you are right, there is a mismatch so I am sending this back for reprocessing and a new payment will be an issue
Ethan: Okay and how many days would it take for reprocess?
Emily: It will take 15 business days
Ethan: Thanks Emily what is the claim number?
Emily: The claim number is A213456
Ethan: And what is the call reference number?
Emily: The call reference number is my name and today’s date
Ethan: Thank you so much Emily you are very helpful to me and you have a nice day
Emily: Thanks Ethan It’s a pleasure talking to you and has a good day
Nicholas: If the check was issued to the incorrect address! the address not matching with the address in CMS 1500 Claim form BOX 32 & 33! Now What would you do and what would you ask a rep?
Ethan: Could you please provide me the check paid to which address?
Emily: Yes Ethan it was issued to the address P O BOX 1234 Belfast Maine 992 92
Ethan: Thanks Emily I verified and found the check address was not correct, we have different check addresses so can you please stop that check you have issued and kindly reissue a new check to the valid address?
Emily: What is the correct address you have?
Ethan: Yes the correct address is P O BOX 86592 Belfast Maine 25833
Emily: Ok Ethan let me reissue the new check to the address you provided.
Ethan: Ok Emily, how many days would it take to reissue the new check?
Emily: It will take 15 business days
Ethan: Thanks Emily what is the claim number?
Emily: The claim number is A213456.
Nicholas: If the check was issued to the incorrect address! the address not matching with the address in BOX numbers 32 & 33! Also, the rep is NOT ACCEPTED to reissue a new check, Now what would you do and what would you ask a rep?
Ethan: Could you please provide me the check paid to which address?
Emily: Yes Ethan it was issued to the address PO BOX 1234 Belfast Maine 99292
Ethan: Thanks Emily I verified and found the check address was not correct, we have different check addresses, so can you please stop that check you have issued, and kindly reissue a new check to the correct [00:05:00] address
Emily: What is the correct address you have?
Ethan: Yes the correct address is PO BOX 86592 Belfast Maine 25833
Emily: Ethan as per our record your provider updated with this address P O BOX 1234 Belfast Maine 99292 and it was sent correctly so I am unable to reissue the new check
Ethan: Emily but as per instruction given by the provider the check should be received at this address PO BOX 86592 Belfast Maine 25833
Emily: Ethan If you still want to reissue the check to a new address, I advise you to send the provider’s updated W9 form.
Ethan: Emily then what is the fax number or mailing address to send the W9 form?
Emily: Ethan you can fax it, to 842-124-3359 with attention to Credentialing department
Ethan: Thanks Emily what is the claim number?
Emily: The claim number is A213456
Ethan: And what is the call reference number?
Emily: The call reference is my name and today’s date
Ethan: Thank you so much Emily you are accommodating me today and you have a nice day
Emily: Thanks Ethan and it’s a pleasure talking to you have a good day.
Ethan: Bye
Emily: Bye.