NHP
When are the NHP products fed through Emptoris?
Never, the NHP line is always MANUALLY loaded.
Where can you find your provider's Medicaid ID number?
Provider Master List on the CNS Requirements Grid
What comments are required when leaving comments for a spinoff?
Reason why spin off is needed, How this information was determined, MPIN/TIN impacted
When should comments be left in Emptoris?
Anytime you are loading, terming or updating information in Emptoris
When should R06 retro code be used?
When using Cred date as Effective date
What product code and IPA is used for providers excluded from NHP?
Product code B1, IPA 780
What type of providers are not to be loaded to FHK (Florida Healthy Kids)?
Internal Medicine and General Practice
If you are loading all commercial products with no NHP what platforms should be selected in PhyCon?
Emptoris only
Once contract is signed in DocuSign, what should you do with contract?
Attach copy in Phycon at PR level and attach contract in Emptoris under attachments
What policy do you access to determine what retro-code should be used?
NC-23 policy in the eGRC
What penalty table is used when loading NHP?
00087
You must submit a request to Titan to have "G" Role and Network # loaded for PCPs or Specialists?
PCPs
If you have loaded commercial, VACCN, Medicare and Medicaid what segments should you select in PhyCon?
E&I, C&S, M&R, M&V
What is required to be attached in PhyCon when you load Medicare for a provider?
Orbit report
What retro code should be used when PCDM is at fault for a request not being loaded in time?
R11C
What type of providers when being added to the network require you to send an email to the NAM to verify if they are part of the FAN network?
Podiatrist or Chiropractor
What standard LOBs are used for loading Medicaid?
260 and 261
What do you always updated the medical necessity indicator to in PhyCon before submitting your GD?
N/A
In PhyCon what should you update your PCP field as if your provider is a specialist?
No
Who do you send retro-code approval to for R11C retro code?
teamlead
For the B1 line what is the directory indicator set to, Y or N?
N
If the Medicaid ID is missing what is your next step?
Route to fulfillment to external documents
Is it required to make sure the Emptoris Doc ID is filled out in PhyCon before submitting your request?
Yes, even if you don't get a red x in PhyCon for not filling this out we will get an audit error if it isn't filled out. Same goes with the Medicaid ID field.
Why is it important to always attach your Orbit report in PhyCon?
It contains the date and time the report was pulled. Sometimes information can change depending on when you pull the report so it is very important to always attach the orbit report you pull to verify that the provider was loaded correctly at the time you pulled it.
Is approval required when using retro code R08C?
No