Scribe Link for “Non-Covered Benefits Process for Claims Workflow”


Apero/Claims Process:

  1.  Confirm that the remit code matches non covered benefit or similar language.

  2.  Confirm that claims are processed correctly either by checking member benefits through appropriate payer portal or by calling the back of the card to confirm.

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

  4. If processed correctly, change the invoice status to “Void” and claim status should already be in “Denied” status. If not, please change the claim status to denied. 

  5. Add appropriate write off labels: “RFNP- Non-Covered Benefit” and “Write off”

  6. Deactivate insurance in Apero.

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

  7. Make notes in Apero 

  8. Mark tasks as “Done”


Retool/Freshdesk Process:


  1. 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.

  2. Resend current GFE.

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

    1. Canned message in FD: “Claims - Non-Covered Benefit”

  4. 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. 

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