NOCD Inc

Scribe Link for “Claims - Member Not Eligible”

Apero/Claims Process:

1. Confirm the claim is processed correctly as non eligible (coverage termed) 

2. In Apero, create tasks for yourself for all affected claims.

3. Move the status of the invoice to VOID for all affected claims

4. Make notes in Apero as to why it was denied/rejected, and what steps were taken to determine it was a write off. 

5. Attach the “Write Off” and appropriate “RFNP- Member not eligible” labels to claims in Apero

6. Set the member’s insurance plan as “Deactivate”

   1. Edit the insurance coverage to include the “end date” for the insurance plan.

7. Mark tasks as “Done”

Scenarios and Statuses for Sending Voided Claims in Apero

Retool/Freshdesk Process:

8. Check eligibility flow to confirm that no new insurance cards have been uploaded.

   1.  If no new insurance cards, proceed below. 

   2. If yes, send over to the eligibility team for verification. They need to let us know if any backbilling/flipping of claims needs to be done as well.

9. End insurance coverage and set cash pay coverage for the date of discovery moving forward.

   1. Check to see if a member has a session on the date, you are changing their coverage. You should still change them to cash, but set the member to “do not autobill,” Additionally, set a calendar reminder to waive the session once invoiced, and set the member back to autobill.

10. Under “Insurance Card Upload Status” select the drop down “request insurance cards” and click “Save Ins Card Upload Status.”

    1. This action sends the member a text message to upload their new insurance card

11. Resend current GFE.

12. Email the member via Freshdesk with the canned message below:

    1. Canned Message in FD: “Claims - Insurance Coverage Termed”

13. If a copay was charged, waive the copay and refund the member. 

    1. If you do not have access to issue a refund, reach out to a manager. 

14. Make notes in retool on all of the steps above.