PHI Basics
What does PHI stand for?
Protected Health Information
What does DNR stand for?
Denied for No Response
Before discussing a patient, what should you confirm?
You are speaking with the provider office.
What should you do if a fax fails?
Attempt the fax again.
True or False: If the most recent status code shows 202 but at the same time the fax sent there's a status showing 200-Fax Received, should you continue to make an outreach?
No, you should route the ticket back to its correct status.
Name 3 examples of PHI.
Patient Name, DOB, Address
What is the purpose of the 902 worklist?
First DNR outreach attempt to obtain missing documentation.
You are working a ticket in 106.
The ticket type is Standard ePA.
What should you do?
Move immediately to 399.
After a second failed fax, what should you do?
Call the provider and verify the fax number.
A voicemail says:
"Please leave a message."
No office is identified.
Can you leave patient information?
No
A patient's first name alone is not PHI. True or False?
False
You are working a ticket in 903.
You complete the second outreach and refax the form.
What must happen before moving the ticket to 904?
Wait for successful fax confirmation.
The provider states the patient is no longer on therapy. What status should most ClinOps workflows move to?
385 – EH Technician
What two resources should you use to find an updated fax number?
Google and NPI Registry
A provider office confirms receipt of the PA form but hasn't completed it. What should you do?
Encourage completion and set callback based on workflow.
Can you discuss patient information with anyone who calls about the patient?
No
True or False:
Tickets in 902 and 903 should only be worked when the callback date is due.
All DNR tickets should be worked regardless of callback date.
You are working a Standard PA in 202.
The office says they never received the form.
Walk through your next steps.
Verify fax number
Refax form
Wait for fax confirmation
Document outreach
Set callback date
Move to 104
A provider office asks you to email chart notes to a personal Gmail account because their fax machine is down.
What should you do?
Do not send PHI to a personal email. Ask for a secure email or escalate.
You accidentally opened the wrong patient ticket. What should you do?
Close it immediately and continue working the correct ticket.
Name 5 pieces of PHI.
Name, DOB, Address, Medication, Insurance ID
A PA Expiry ticket enters 399.
The PPA expiration date is still active.
No documentation has been received.
Should denial letters be created?
No.
Move the ticket back to the previous outreach worklist (104, 105, 106, or 107).
The provider advises the physician no longer works there. What should you do?
Follow workflow routing/escalation procedures and document appropriately.
If faxing continues to fail, what should you ask the provider office for?
A secure email address
What steps should an agent take to make an outreach on a PA expiry ticket that shows an additional information request form was sent?
The agent should review the ticket history and confirm that an Additional Information Request was previously sent by the EH Pharmacist. The agent should then contact the provider's office and advise them that we are following up on the Prior Authorization renewal request and that additional information is still needed to complete the review.