Apero/Claims Process:

  1. Confirm the member has a Medicaid/Medicare plan (only applies if this is their primary insurance)

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

    1. Send voided claims per the situations described in the table below.

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

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

  5. Attach the “Write off” and “RFNP - Insurance OON” labels to claims in Apero

  6. Mark ta234sks as “Done”


Scenarios and Statuses for Sending Voided Claims in Apero

 

Scenario/Denial Reason

Send voided claims to insurance?

Invoice Status

Claim Status

Back Bill as Cash? 

Medicaid/Medicare plan

Yes

Void

Denied

No


Retool/Freshdesk process:

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

  2. In Retool:

    1. Place a check mark in the box “Mark as medicare/medicaid/medi-cal” and select “Save”

    2. In the “Manual Scheduling Restriction” box, select “disabled_by_billing” and select “Save”

    3. In the “Auto Billing State” box, select “do_not_autobill” and select “Save”

  3. If this is an Active member, keep the next scheduled session and cancel any sessions after that date (because we are allowing a discharge session). Notify a manager if you need assistance with this

  4. If this is an Active member, email the member via Freshdesk using the canned message option below:

    1. Canned message in FD: “Claims - Medicaid/Medicare Waitlist (Allowing Discharge Session)”

    2. IMPORTANT: CC the member’s therapist on the email for transparency in that the member’s next session will be for discharge

  5. 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. 

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