2014_GNE Co-pay Test

Testing Quia ability to be utilized as an audit tool
Name: 


A red asterisk (*) indicates required questions.

  1. Please list Claim number you are auditing*


  1. Did SHOV Place claim in correct queue?*
    Yes
    No


  1. If No please explain queue error:


  1. Did SHOV enter Member/Provider details correct?*
    Yes
    No


  1. If No please Explain incorrect details:


  1. Did SHOV Enter in the claim history?*
    Yes
    No


  1. If no please explain:


  1. Was this a Duplicate payment?*
    Yes
    No


  1. If yes please provide previous payment details:


  1. Is this an adjustment?*
    Yes
    No


  1. If yes, please provide adjustment details:


  1. Did SHOV Enter Calculations tab correct against Siebel?*
    Yes
    No


  1. If No please explain incorrect calculation:


  1. Pay Correctly?*
    Yes
    No
    N/A


  1. If no please explain cincorrect payment:


  1. Deny Correctly?*
    Yes
    No
    N/A


  1. If no please explain incorrect denial:


  1. Is this a split fax?*
    Yes
    No


  1. Comment on split fax:


  1. Were the notes clear and accurate?*
    Yes
    No


  1. If notes were NOT clear and accurate please explain:


  1. Were all denial reasons stated upfront?*
    Yes
    No
    N/A


  1. If no please explain denial reason error:


  1. Was the claim pended for appropriate time frame?*
    Yes
    No
    N/A


  1. If no please explain pending error:


  1. Was this claim catagorized accurately? (pay, deny, incomplete)*
    Yes
    No


  1. If no please explain catagorization error:


  1. Please add any additional comments for this survey: