Service Category & PAL (Humana)
The service category for 67917.
What is Blepharoplasty?
The standard TAT for a Medicare request.
What is <14 calendar days of receipt of request?
You are in the Aux code of Inbound when you are taking inbound calls.
What is FALSE? Correct Aux code is Ready.
The work instruction that includes a step-by-step on how to answer calls, suggested scripting and steps to take based on different types of calls.
What is Inbound Phone Process?
Service Ops uses this for 3 main things: 1) queue management, 2) logging interactions and 3) reporting.
What is Salesforce?
The service category for 62323.
What is Epidural Injections (Outpatient Only)?
The TAT date & time in Salesforce for SR-576316.
What is 8/12/2021, 11:59 PM?
Use Aux code "Away From Desk" for incidents when you need to step away for something unscheduled (bathroom break, emergency, etc.).
What is TRUE?
Where the chart covering what functions intake handle based on payer/client is found?
What is the Intake Work Instruction Launchpad in Service Ops?
The tab that is highlighted in a light blue color in Salesforce.
What is the active tab?
The Cohere PAL where CPT code 45380 is found.
What is Cardio & Surgical Services?
The standard TAT for a commercial request in the state of Illinois.
What is <5 calendar days of receipt of request?
You can put PHI in Slack when trying to resolve an important issue.
What is FALSE? - No PHI in Slack! You should use gmail and Virtru to send PHI.
The work instruction you should use if you receive an OON pop up when submitting an authorization in the Portal.
What is Out of Network (OON) Intake Process?
The section in Salesforce that will show logged interactions and where emails and faxes can be sent.
What is Activity?
The service category for 61860.
What is Neurostimulators?
This state has a standard commercial TAT of Within 72 hours or 2 business days, whichever is less.
What is Maine?
You do not need to check/refresh your schedule regularly as it is not likely to change once it has been posted.
What is FALSE? - WFM/BP updates schedules throughout the day based on real time business needs so you need to check and refresh regularly.
Avera, Blue Cross Blue Shield Of South Carolina, Geisinger, HealthPartners, Humana, Medical Mutual of Ohio, Oak Street Health.
What are Cohere's current payers/clients as listed in the Scope/PAL work instruction.
How you can return to the Dashboard in the Portal?
What is by clicking on the Cohere Health icon at the top of other sections in the Portal.
The PALs where CPT code 78429 is found.
What is Humana and Cohere's Diagnostic Imaging and Sleep Studies PALs?
This is how the required determination timelines are set.
What is standards required by the State and Federal government for different types of requests (Standard or Expedited)?
Once you know how to work a function, you no longer need to use your work instructions.
What is FALSE? - Processes, tools and resources - and therefore work instructions - change on a regular basis. You should ALWAYS use your work instructions no matter what you know or how long you have been at Cohere.
The section on the left-hand side in Confluence that includes pages for Navigating Confluence, Hold Timer, Definitions, Abbreviations & Commonly Used terms and other valuable tools.
What is Tools for Productivity?
The area/section in the Portal where outreach attempts for nudges, missing information and P2P are found.
What is Patient Summary/Clinical Outreach?