Phycon Requests
You get a request to add a TAX ID and add contracts. Which do you work first?
TAX ID; Demo
What do you do if the date in the EFF DATE field is prior to the requested panel date?
Terminate the active panel one day prior to the required panel date-THIS IS ON THE EXAM
When terming a PCP, what information is required?
PCP reassignment MPIN, IPA number and add seq number
Does every provider get enrollment rules
No, it depends on the provider and their state.
When performing a TIN Maintenance, Add/Inactivate request, what will you perform first?
Add then Inactivate. THIS IS ON THE EXAM
You get a request to load Medicaid LOB's for a Specialist in Texas but there are no enrollment rules on the request, what do you do?
Send for a clarification
When researching contracts for Medicaid, Commercial and Medicare to see if they're already loaded, what screens do you use
4, E, W
What is the function to term multiple contracts at once?
K
When completing a change request for a Medicaid contract, what section of the BSAR tool do you use?
LOB Maintenance
A provider wants to be Non Par, what kind of termination is this?
Contract
Close it. They have to submit it using the right transaction.
What screen do you access after you get the error #59 Panel has overlapping dates?
I-W-Z-THIS IS ON THE EXAM
You get a request to update the PCP Indicator and Effective date as a Product Modification. How do you update the contracts?
Inactivate products, add products
You have a request to update the agreement ID's, what is the function to do that?
Timeline
A provider left one group and joined another group. Both groups are under the same TIN. What kind of TIN Maint request will this change generate?
PTI MPIN Linkage
Your request is to update the PTI MPIN and it's for a practitioner. Do you work it?
No, those requests have to be submitted at the group level with the exception of the provider being the legal owner of the TIN.
When terming Medicare contracts, what do you also have to check?
See if any RO lines with the CM's need to be termed as well.
On the Contract detail information screen, what is used to identify a Shared Provider?
Con Arr field-THIS IS IN THE EXAM
When looking for the most recent effective date for LOB's what date do you look at? The original date or the date listed after selecting that LOB?
Make the selection to the LOB to see the latest effective date.
What must you do before submitting or saving any loading data?
DOUBLE CHECK!
You get a request to term the TAX ID and contracts. What do you work first?
Term the contracts then term the TAX ID.
What information is needed for PCP contracts?
G role, PCP number and network numbers
When might you need a clarification for a Commercial contract?
Missing PCP reassignment info, contradicting CM's and/or missing CM's.
If there is no BSAR relationship, how do you create one?
Add BSAR to the F9 on all PLSV's and Combo's for the TAX ID.
What is a Full Term, Contract Term and a Product Term?
Full term= Terminations of all contracts for a practitioner or group
Contract term= Termination of an entire contract for all associated MPINs and TINs for a practitioner or a group. Provider wants to be Non Par
Product term= Terminations of a specific product in the contract (Medicaid, Medicare, etc.)