Syncro CRM Escalations & Documentation

Appeals — 45-60 Business Days

• Appeals involve insurance claim disputes initiated by patients/providers.
  Important:
• Natera cannot appeal on behalf of the patient.
• Patients remain responsible for charges during the process.
• Confirm escalation validity via the “Appeals” KB article.

Callback from PTP/PTE — 48 Business Hours

Escalate when a PTP/PTE queue call cannot be completed after 2 minutes of waiting.

Do Not Contact Me

• Escalate when a patient requests no further contact via calls, messages, or mail.

Executive Escalation Keywords

Escalate when patients use terms like:

• Better Business Bureau, Attorney, Lawyer, Lawsuit, Harassment, Fraud, Bankruptcy.

Action: Transfer to Escalations Team and submit an “Executive Escalation Keywords” ticket.

Itemized Bill (PTP Payment) — 5-7 Business Days (Phone), 3-5 Business Days (Email)

• Patients may request an itemized bill for PTP payment confirmation. Ensure:
  • Account is fully paid and reflected as closed to prepay.
  • Payments or $0 balances are shown in AMD’s History tab.
  • Escalation is sent via Syncro CRM.

Itemized Bill — 5 – 7 business days – phone requests or 3 – 5 business days – email requests –

• Purpose of an Itemized Bill:
  • Provides detailed descriptions to help patients confirm their account has been paid in full and that no additional balance is owed.
• Insurance Requests:
  • Itemized bills cannot be sent directly to insurance.
  • If an insurance representative requests one, direct them to email their request to [email protected].
• Account Status Requirements:
  • The account must be fully paid, with the payment or zero balance (ZBAL) reflected in the AMD history tab.
  • For accounts where no payment was required, the account must be marked as written off in AMD’s history.

Insurance Update —30-45 Business Days (Insurance Response)

Update insurance details when:

• Adding or modifying new commercial or Medicaid insurance coverage.

Medical Records — 45-60 Business Days

• For requests to send patient medical records (insurance or patient-initiated), escalate with the appropriate email or fax details.

Missing Payment — 5-7 Business Days

• If a patient claims they paid but the payment is not visible in AMD, Synergen Pay, or payment.natera.com:
  1. Request proof of payment (e.g., transaction ID).
  2. Submit the escalation with proof.

ONC Callback — 48 Business Hours

Escalate when:

• Calls related to Oncology or Organ Health tests (e.g., Signatera, Prospera, Altera) go unanswered in the Sig_inbound queue.

Patient Callbacks — Within 24 Hours

Escalate when:

• A patient requests a callback due to an inability to remain on the call.
• Supervisor or manager escalation requests go unanswered.

Patient SOS

Escalate immediately for:

• Repeat issues (two or more unresolved attempts).
• Complaints were unresolved via standard channels.
• Irate, unconsolable, or distressed patients.
  Action: Transfer the call to the Escalations Team and submit a “Patient SOS” ticket.

Refund Request — Up to 60 Business Days

Refund requests should meet the following criteria:

• Overpayment by the patient or overcharges by the team.
• Payment is reflected in AMD at the time of escalation.

Requisition Form Request — 7 – 10 business days 

If the patient requests a copy of his / her requisition form

 SYNERGEN ESCALATION — 3 business days

Submit a Synergen escalation in the following scenarios:

1. No Valid Balance on Synergen Pay:
   • When the account displays no valid balance.
2. Payment Portal Errors:
   • If the patient encounters errors such as:
     • “Invalid Case”
     • “Payment Already Made”
     • “Incorrect Balance”
3. WODUNN Code on AMD:
   • Cases with a WODUNN code need to be escalated.
4. Written Off Balance:
   • When the account shows as “Written Off” and the correct balance needs to be added.
5. Voided Statement:
   • When the account shows “Voided Statement” and the correct balance needs to be added.

Supervisor Escalation — 2 Business Days

Submit a Supervisor Escalation ticket when:

• You attempted to transfer the call to the Escalations Team (e.g., for payment plans, issues with Synergen Pay, patient refusals, or red flags), but no one answered.
• A Straight Medicaid claim was denied due to timely filing, and the balance needs to be written off.
• A patient continues to receive bills despite a Medicaid insurance update exceeding TAT.
• Account modifications (e.g., address, phone number, or email) require escalation.
• A Hold Status is detected in AMD/History.
• A digital statement was issued due to a bad address. Update the address, place the account on hold, and escalate.
• An insurance update sent over 45 BD ago remains unresolved.
• Patients insist on adding insurance for cases exceeding 180 calendar days from the service date. Explain the situation, likely denial, and escalate if necessary.

SPAY Error Issue — 3 Business Days

Escalate if:

• The patient doesn’t receive the payment link.
• The payment link returns an error.

Stop Claim — 30-45 Business Days

Use Stop Claim requests for the following:

• Natera employees or partners tested and should not owe a balance.
• Redraw billing errors.
• FSA/HRA/HSA refunds required, transitioning the case to self-pay.
• Incorrect clinic vs. insurance billing.
• Cases with Progyny coverage billed incorrectly.
• Patient payments sent to insurance in error.

Note: Never stop a claim for Compassionate Care applications.

WO CODE ERROR —  within a week 

• When you have identified some incorrect or uncommon write-offs being applied to the accounts.
• Please review the ‘History’ tab carefully. If the account shows a $0 balance but an uncommon write-off code was used and no notes explain why, you must escalate the issue before informing the patient that they no longer have a balance.

 ZBAL —  7 – 10 business days 

Submitting a ZBAL request is essential for clearing outstanding balances, particularly for cases with lower rates. Below are the specific scenarios for submitting ZBAL requests:

1. Payments for Compassionate Care Approval:
   • Submit a ZBAL request only after a payment has been received.
2. Scenarios Without Payment:
   • 100% Compassionate Care Approval: When patients are approved for 100% Compassionate Care (no payment required).
   • Non-Proof of Income Form: When a non-proof of income form is attached to the requisition form, quoting a $0 balance.
3. Courtesy Exceptions:
   • If a Courtesy Exception was confirmed but the balance wasn’t removed, you may submit a ZBAL request.
   • Ensure you have supporting notes or memos indicating that the RD escalation was approved before submitting.

Related Topic:

Turnaround Times 2024

Last update by: Claudia F (Dec 2, 2024)