CLIENT UPDATE
Claims Processor Start Date: 5/5/2015 Education: Brookline College Medical Insurance Billing & Coding
Strengths:
• Love of Learning • Open-Minded • Adaptability
Weaknesses:
• Too critical of myself • Always trying to please others • Pessimistic
Best Part of Working at UCS:
The best part is working with my co-workers. They are all absolutely wonderful people!
Hobbies:
• Reading & Writing • Cooking & Baking • Spending time with my family & loved ones
Do you have any pets?
I have a dog named Biscuit & a cat named Peeps.
Favorite food & beverage?
Shrimp Fried Rice & Snapple’s Peach Tea.
Favorite TV Shows/Movies: • The Big Bang Theory • The Fifth Element • Beauty & the Beast • Night Watch
What major goals do you hope to accomplish someday? Right now, I am shooting for passing the CPC exam. That is at the very top of my list!
Who is your role model & why?
My mother. My mother is strong, loving and has a beautiful soul. One day, I would like to be just like her or be someone she can be proud of.
What is your greatest accomplishment?
Probably working at UCS. UCS is my first actual job and it’s a great experience that is teaching me so much!
What is your biggest regret?
Not taking high school more seriously. I wish I had applied myself more in school, in order to get a scholarship, to be able to go to a university.
Do you collect anything?
Books! I LOVE books! I want to build my own personal little library.
Which cartoon character do you think you relate to the most & why? Louise from Bob’s Burgers. She is evil...and apparently, so am I. (When asking my family this question, they all said Louise.)
My family includes:
Mom, Dad, 2 younger brothers & 2 younger sisters
Favorite board game? Chess
Favorite Quote:
Happiness can be found, even in the darkest of times... if one only remembers to turn on the light. Albus Dumbledore, Harry Potter & the Prisoner of Azkaban
NEW EMPLOYEES... PATTIE FOX
Claims Examiner I I have been involved in medical billing for 24 years in various specialties, hospitals and pharmacies in Arizona, Minnesota and Texas. I was born in Albuquerque, but moved to Arizona when I was two years old.
Although I grew up in North Phoenix, I started moving around a little after high school. I have two little dogs and am interested in photography and traveling. I love my two grandsons and SOMETIMES my children. I’m happy to be at United Claim Solutions and look forward to working on your claims!
BRIAN CASABAL
Regional Contract Manager Here at NX Health Network (child company to UCS), I am a Regional Contract Manager. I enjoy recruiting providers into our network to help members get the best quality of care in their communities. In the past, I recruited providers at a federal contractor and at an IPA in the Los Angeles area. I am a native Chicagoan. I left at a young age after my grandmother, who lived near San Jose, visited and encouraged my parents to move to the warmer climate of California. I lived in California (Bay Area, Orange County, and San Diego) most of my life. After experiencing years of being stuck in traffic on the 5 and 405 Freeways, I decided to look for somewhere less congested to live. I got to know Phoenix after watching several impressive YouTube videos. I made my first visit in May 2014. I moved here three months later, without knowing anybody in town. I love living in Phoenix. To give back to this great city, I have volunteered at the Salvation Army’s dinners at Thanksgiving and Christmas every year that I have lived here. My favorite sport to watch is hockey (Go Coyotes). My favorite outdoor activity is hiking, which I am blessed with many choices in Arizona.
WELCOME ABOARD! KELLY STEARNS Claims Examiner I
I was raised in Oregon, but finished high school in Alaska. My dad worked on the pipeline from the time I was born until I graduated. I graduated with a degree in microelectronics. I am somewhat of a closet-nerd. I am a former dragon-boat racer and made it to the World Race in 2002. I enjoy hiking, yoga and good competition in sports. I am a die hard black & yellow Steelers fan, and also of fan of the Pirates, Penguins and Hello Kitty.
COMING NEXT MONTH... CASSIE INGRAM AND MORE!
Lymph Node Lesson: Not Just Ever visit a physician when you have a sore throat and the physician feels around the neck area? Ever wonder why? The physician is feeling for swollen lymph nodes (AKA lymphadenitis). Lymph nodes are bean shaped glands that play a vital role in immunity. The lymph nodes, in addition to the spleen, tonsils, thymus and adenoids comprise the lymphatic system. The lymphatic system helps protect the body from infections.
Lymph Nodes
Neck Collarbone
Peas
Armpit
Bean Groin Lymph nodes are located throughout the body. There are lymph node clusters in the neck, under the chin, under the arm and in the groin. The nodes are generally not felt – unless they become swollen. Lymphocytes, produced by bone marrow, migrate to the lymph nodes. There are 2 types of lymphocytes, B and T. B cell lymphocytes fight active infection and make antibodies. T cell lymphocytes attack the body’s cells when they have been taken over by viruses or have become cancerous. Some T cells kill virus infected cells directly. So, why do they swell? The body increases production of lymphocytes when a person has an illness or invader (virus or bacterial). Examples include the common cold, influenza, abscessed teeth, ear infections, and strep, etc. The lymphocytes travel to lymph nodes close to the site of infection. This causes the lymph nodes to swell. A structure that normally can’t be identified, is easily located because it has swollen to the size of a kidney bean (or larger). Warm compresses applied to the area may ease the tenderness of swollen lymph nodes.
Another Bean-Shaped Gland Swollen lymph nodes will move when pushed around. This is normal. When the cells housed in the lymph node attack the invader and the offending organism is defeated, the lymph nodes start decreasing in size and return to their usual state. If the lymph nodes become so swollen that there is difficulty breathing or swallowing – seek immediate medical care. Prolonged swelling of lymph nodes after an infection may indicate there is a complication of the illness. One complication may be abscess formation. An abscess may require drainage and antibiotics. Worse yet, the prolonged swelling may indicate a progression to sepsis. (Remember sepsis? Sepsis can lead to organ failure and death.) There are some medications can cause lymph nodes swelling. Dilantin (phenytoin) and preventative malaria medications are known to have this affect. Fortunately, this side effect is rare. Abnormal lymph node signs and symptoms should always be evaluated by a medical professional. Chronic swollen lymph nodes can be present with some conditions. Examples are HIV, mononucleosis, lupus, rheumatoid arthritis and other immunodeficiency conditions. Abnormal signs and symptoms are listed below. • The lymph node swells for no apparent reason. • The lymph node continues to enlarge or has been present for 2-4 weeks. • The node is hard and does not move when pushed. • Persistent fever, night sweats or weight loss are present. Cancer may also be a concern. • Lymphoma is cancer that originates in the lymphatic system. Many times the only sign of lymphoma is a persistent enlarged lymph node in an otherwise healthy person. It is the mostcommon cancer in young people. • Leukemia is cancer that originates in bone marrow. Cancer is unregulated growth of cells. The abnormal cells may survive better than the normal cells. Eventually, the leukemic cells suppressthe development of normal cells. • Enlarged lymph nodes may be an indication of metastatic disease. There are other legitimate reasons to be concerned when there is lymph node swelling. These conditions can be treated. Medical News Today Lymphoma: Causes, Symptoms and Research Jan. 2016 Leukemia and Lymphoma Society Science Museum
THE
Guarantee PROGRAM UCS will support and guarantee all of its savings on Ambulatory Surgery Center claims, as well as Substance Abuse Facility claims related to drug, alcohol rehabilitation, detox, residential care and group therapy. This includes appeals management, legal assistance if needed and any additional payments to the provider required to settle the matter.
OVERVIEW Over the past eight years, our Clients have asked us to investigate and resolve issues related to several thousand Ambulatory Surgery Center and Substance Abuse Facility claims. Through the combination of those efforts, UCS believes that we have a solution for clients facing the rising costs associated with this type of care. Utilizing the expertise of our Certified Coding and Medicare Repricing Teams to review these claims, UCS has developed a response that provides dramatic savings and allows health plans to comfortably walk away from unreasonably high charges with confidence. Assuming the roles of appeals manager, negotiator, and payer of additional charges, the UCS solution removes the Health Plan from further noise, energy and liability.
THE UCS SOLUTION PROCESS
1
Upon referral of the unpaid claim by our Client, UCS will review the details of the claim to make sure that it is related to ambulatory surgery centers or facility charges for drug/alcohol rehabilitation, detox, residential care and/or group therapy as outlined on the “Identifying Ambulatory Surgery Center & Substance Abuse Facility Claims� flyer.
2
After review, UCS offers its clients a reimbursement rate for the claim which is subject to deductibles, co-pays and other patient liability provisions of the health plan. The client is asked to reimburse the provider based on that repriced amount, and place the UCS toll-free number on the EOB for questions and answers.
3
All follow-up related to the claim will then be handled by UCS. Provider inquiries, repricing methodology questions, appeals, negotiations and letters to the provider are handled by the UCS Team.
AVERAGE SAVINGS Average ASC Savings
Average SAF Savings
72%
56%
UCS manages all provider inquiries to resolution.
Employee Birthdays: April 18: Luigi Bianchi, Director of Application Development April 23: Jorge Juarez, Regional Contract Manager
Anniversaries: April 28: Dave Loveless, Account Manager 3 Year Anniversary April 21: Linda Myrick, CPC, CPC-I, Edit & Special Projects Manager 3 Year Anniversary
March Contest Winner
Alice McDonald $25 VISA Gift Card & Pot of Gold
Why she feels lucky to have UCS as a Cost Containment partner: “As do all organizations, we work with many vendors. I have never experienced the personal and consistent contact and support that we receive from Pam Burns. Pam checks in frequently and is known by us for her prompt response even if that means she needs to do so from an airport. It is good to know that when we have a situation we need help on NOW, that Pam will be there for us to assist with providing the support needed to exceed our clients expectations. One area where we have been able to do so involved very high dollar claims for substance abuse that, without the UCS product, could have been catastrophic for our client. UCS negotiated incredible savings that allowed us to guarantee to our client our ability to manage this type of situation. Thank you so much.�
SPRING CLEANING CLIENT CONTEST Does your workspace need a HAZMAT suit? At times, mine sure does! Work days can be long, tiring and our desks/offices can end up looking less than stellar. I propose we all do a little spring cleaning! Your mission, should you choose to accept it: Send us a picture of how “CLEAN” your desk/office is, and you will be entered into a drawing to win a $50 GIFT CARD! Let’s start the season off right! FYI: Make sure to remove all information/paperwork that should NOT be shared or simply flip it over!
Email your submissions to: Amanda Hertig Marketing Specialist ahertig@unitedclaim.com
CLIENT UPDATE
23048 N 15th Ave Phoenix, AZ 85027 (866) 762-4455 www.UnitedClaimSolutions.com