Predict Errors
What SOP must be used to resolve any pre-defined business rules?
S1059
NDB PREDiCT - Provider Error Detection and Correction Tool
An agent is informed through a request that an existing provider needs to be added to another group other than what he/she is already associated with. This change triggers what kind of maintenance?
Demographic/Tax ID Add
Once a user enters the MPIN, TIN, and name of provider and hit enter, which screen displays in NDB?
Selection Screen
Par providers are credentialed through whom?
NCC
Where should you save all important documents, OneNote, and other materials you'd like to potentially share later with someone?
Network/OneDrive
According to S1059 business rule 038, what should be done if the CORP name and PTI name DO NOT match exactly?
Proceed to Step 5 and check the I/A/Z for every Bill/Combo to ensure the DBA name field is populated with the PTI name
Dr. Deflores has notified us that she will be joining ABC Medical Group and would like to be contracted with their Medical Group Agreement (MGA) Contract. What kind of transaction request will this be in PhyCon?
Contractual/Practitioner Add to Group
Which field is used for navigating within the sub-system menu?
CATOGERY
What ten digit number is issued to a provider by Centers for Medicare and Medicaid Services (CMS)
NPI
What type of address can never be under a BILL in NDB on the selection screen?
COMBO
Refer to the NDB Predict - Provider Error Detection and Correction Tool S1059 SOP for Business Rule 052 - License Number Validation. If the state license number is not found on the Source of Truth (SOT) what do you do?
Check the CNR box in Predict for rule
A request came through for the DLA to add a CLIA number to a provider. What type of transaction would this be?
Demographic/Other
What type of address must a user be in when navigating to the I/A/M?
PLSV or COMBO
What is the difference between a P-Type and an O-Type Record?
P is Individual
O is for an Organization
Before submitting a GD in PhyCon you must clear all of these?
Flags
According to the NDB Predict User Guide J4144, how do you resolve errors?
-Use outside resources such as NPI Registry or USPS websites
-Additional research of same/other provider within NDB
-Source of Truth (within the current PhyCon Transaction)
-PhyCon History/PR or GD transactions within last 60 days
An MPIN needs to be reactivated in NDB. What type of request does this trigger in PhyCon and what type of transaction has it shown up as in PhyCon recently?
Demographic/Non Par Practitioner Add
What is the correct format for a wild card search with a last name of only 4 characters?
4 characters and a space, then include an asterisk
What can have up to nine digits and is assigned to the provider by UHC?
MPIN
Which screens are Address specific to an MPIN/TIN
A, L, I/A/M
What screen does an agent need to visit if Business Rule 027: PCP ID/UHCID Alignment populates after running Predict?
IWZ
What is the difference between TAX ID and TIN in reference to the Loading Transaction Definition Guide?
TAX ID: Demographic
TIN: Contractual
What five categories do Non-Del users visit that are in an area other than Z?
I/H/A
I/F/C
I/A/M
I/D/C
I/T/C
What are the four reasons of why a Tax ID change would occur?
A provider decides to incorporate.
A provider joins a group of physicians.
Multiple providers decide to form a new group.
A provider decides to go into practice with another individual provider.
If you do not touch NDB at all, what does the agent place in the Predict ID field in PhyCon?
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