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Settle the primary payer. Then bill the visit.
Settle the primary payer. Then bill the visit.
Settle the primary payer. Then bill the visit.
An administrative assignment with conflicting insurance information, a completed questionnaire, and a visit that still needs to be billed.
An administrative assignment with conflicting insurance information, a completed questionnaire, and a visit that still needs to be billed.
Synthetic patient · Source task specification · No model results presented
Synthetic patient · Source task specification · No model results presented
The assignment
The assignment
The assignment
Source instruction excerpt · Synthetic scenario Ottoline Bramhall-Vance (MRN-77341) has been sitting on the eligibility queue since Tuesday. She is 68 and still working, she has Medicare as well as a plan through her employer, and her completed Medicare Secondary Payer questionnaire came back on the fax on 9 June, the same day she brought her Medicare card to the desk to be scanned. Registration’s order of payment and what the plans themselves say do not line up, so go back to both plans and to her paperwork and settle who is genuinely meant to pay first for her.
Source instruction excerpt · Synthetic scenario Ottoline Bramhall-Vance (MRN-77341) has been sitting on the eligibility queue since Tuesday. She is 68 and still working, she has Medicare as well as a plan through her employer, and her completed Medicare Secondary Payer questionnaire came back on the fax on 9 June, the same day she brought her Medicare card to the desk to be scanned. Registration’s order of payment and what the plans themselves say do not line up, so go back to both plans and to her paperwork and settle who is genuinely meant to pay first for her.
The remainder of the instruction requires the chart and June 4 visit to be corrected, the patient to be informed, and the queue item to be closed with evidence. The March visit must remain untouched.
The remainder of the instruction requires the chart and June 4 visit to be corrected, the patient to be informed, and the queue item to be closed with evidence. The March visit must remain untouched.
What the task asks the agent to do
What the task asks the agent to do
What the task asks the agent to do
Reconcile the evidence
Reconcile the evidence
Reconcile the evidence
Read the card scan and questionnaire, check eligibility with both plans, and use the billing guidance to determine the correct payer order.
Read the card scan and questionnaire, check eligibility with both plans, and use the billing guidance to determine the correct payer order.
Read the card scan and questionnaire, check eligibility with both plans, and use the billing guidance to determine the correct payer order.
Correct the chart before billing
Correct the chart before billing
Correct the chart before billing
Update the supported insurance details and payer order, then prepare and validate the claim for the June visit.
Update the supported insurance details and payer order, then prepare and validate the claim for the June visit.
Update the supported insurance details and payer order, then prepare and validate the claim for the June visit.
Submit and close the loop
Submit and close the loop
Submit and close the loop
Submit the claim, tell the patient what changed and what to do next, and close the queue item against the submission evidence.
Submit the claim, tell the patient what changed and what to do next, and close the queue item against the submission evidence.
Submit the claim, tell the patient what changed and what to do next, and close the queue item against the submission evidence.
Preparing is different from submitting.
Preparing is different from submitting.
Preparing is different from submitting.
The task specification checks whether the claim was billed to the primary payer, whether the group plan was explicitly promoted, whether the patient was notified after correction, and whether closure evidence was produced.
The task specification checks whether the claim was billed to the primary payer, whether the group plan was explicitly promoted, whether the patient was notified after correction, and whether closure evidence was produced.
The task specification checks whether the claim was billed to the primary payer, whether the group plan was explicitly promoted, whether the patient was notified after correction, and whether closure evidence was produced.
The check is whether the claim was billed to the correct payer. A draft claim alone does not establish that the visit was billed.
The check is whether the claim was billed to the correct payer. A draft claim alone does not establish that the visit was billed.
This is an explanation of the authored task and its checks. No agent run or model score is presented.
This is an explanation of the authored task and its checks. No agent run or model score is presented.
This is an explanation of the authored task and its checks. No agent run or model score is presented.