Mentor
This document that you should keep open houses most of the other documents you might need on any given call.
Document Index CCC Provider
CRI Screen
This is what we use to create our cases
Quick Start+
Plan member page
What information do you need from the provider in order to give payment details
that payments check#,EFT#,or Bop# or 2 id numbers of other checks,eft,bop for the same provider for any other member
This document is what you would use for Authentication purposes for all calls and issues.
HIPAA Overview CCC Provider
You would use this screen to display 1 specific claim for a member
MHI Screen
This field in Quick Start+ needs to be selected if you are logging a claim or authorization status. EXACT name of the field
Please see logged information
This screen you need to be on to see if the member has other insurance
Plan member page on the left side under plan information
Hi this is Pauline from Dr Richs office I need to see if some codes are billed? What do you need to use to check if the codes have been previously billed.
DIG Toolbar>Procuedure Code Search
This document tells you about documentation and what information we will be logging on calls.
Internal Documentation Rules and Standards Overview CCC Provider
You can add these to the end of the MHI control line to display more field descriptions, Example: method of payment, or LCD/NCD denial
MHI Screen *Modifiers*
These calls Require you to document comments to your case in CRM. List all 4
Escalations/Threats
Routing a case to another team
Unable to resolve call during initial phone call
Outbound call/callback needed
This quick link is what you click when needing to find a claim
Claim summary
When you get a call and nobody is on the line, this is an example of a...
Ghost Call
Escalation Procedure CCC Provider
This screen displays the accumulation history information for the member or plan by a specific month and year
MAI Screen
If you are creating a case and sending claims back for 2 different members how many cases do you need to create
2 cases 1 for each member
This quick link is where we see if the provider or member has an appeal.
Grievance & Appeal Status
When a provider requests to speak to a supervisor and you are transferring them to the Escalation Unit, you are doing a ____ transfer
Warm/Consult
SNF Calculator CCC Provider
This screen is what you would utilize in CAS to find the Hospice dates for a member.
CWI Screen
What do you do when you receive a Ghost Call
This is the screen you would log the claim number on to your case.
Claim Summary
If a provider wants to speak with the members care manager, what system do you need to utilize to send a task for the provider.
Guiding Care