Initiation
Give one authorization details you have to verify.
DOS, LOS, Patient Name, CPT, ICD, Orientation, Facility
The ordering provider could be a?
- Medical Doctor
- Physician's Assistant
- Nurse Practitioner
What does AVRS mean?
Automated Voice Response System
Enumerate the Five D's
- Details of Task
- Directives
-Discrepancies
- Duplicate
-Denial/Approval on file
Any changes made by the provider can be found in?
History
What will be your tagging for IPA tasks?
- NPA > Other
If the facility or ordering provider is out of network, what are the things you need to verify?
- NPI, Tax ID, Address
A non-clinician who gathers information and order details
Intake
Where can you find the fax #?
- Directives
What is the tagging if DOS is not covered by effective dates?
Need Practice Attention
Evicore confirmed that the insurance of the patient has expired. How will you proceed?
- Call healthplan
If facility’s NPI is not available on the task, where will you check it aside from the NPPES.
Authman Receiver
Provide at least 3 TPA
- AIM
- Evicore
-NIA Magellan
- Health Help
What is the tagging if the DOS is changed after approval?
Update with Payer
You are calling Health Help, you verified that the NPI, tax ID, and address of the facility is correct but it is still out of network. What will you do?
- Ask if it is possible to proceed with the authorization for the facility.
You’ve reached a confidential voicemail. You are the first CP to handle the task. Definitely, you will leave a message. What will you say in the message?
-
Hi, my name is ___, calling on behalf of doctor’s office. I am calling to ____ (purpose of call). This is for PATIENT NAME, BIRTHDATE, MEMBER ID. Anyone from our office will be more than glad to discuss this in detail with you. Please use REQ # as your reference number. Please call us back at 855-9957088.
How can you know if the task is a duplicate?
If it has the same DOS, LOS, CPT, ICD, Orientation (if avail), Ordering provider, Facility
What would the CP do if there's no available reference call number?
Ask the intake's name, date and time
Give 5 options that you will choose why the Widget is not working.
- Error while loading Widget
- System not Available
- Case Not Found
- Code Blocked
-Ordering provider not found
- Facility not found
-other
Give one scenario when a task can be identified as an IPA
- Insurance pacakge specifically says IPA in the title
- Directives informs you to move the task back to practice due ti a specific insurance package
- Determine via call that the payer handling the authorization is an IPA
If DOS is more than 30 days away from today, and it is a non-imaging task (surgery), what will you do?
Proceed with auth and status accordingly.