Tooling Around
Get it sorted! In our Site list, this is the order we want to arrange our workable requests when we first start working.
Largest number of chases to smallest
Member Name, insurance number, and full date of birth are all examples of PHI also called this:
Protected Health Information
The provider tells you that they don't have to participate in HEDIS even though we have claims with their provider and member.
That's trash! Providers that receive payments from Medicare, Medicaid, or our commercial plans are required to participate to remain in compliance.
This is the default letter we'll be sending for the majority of the project, we'll let you know when we're switching it up
Packet with Measure
The office responds to your test email with an official letter from Hospital Corporation of America, what to do...
Code as HCA_ or HCAP_ so we can move these to special handling
Provider telling you they've already sent in records? Check the notes icon and the Modified date to see if they have one of these on the chase
A Secondary Request or Request for Additional Information
This is what they would be asking for if a provider wants the member DOB and DOS
The provider tells you that there's a law that requires us to send them a signed member consent before sending records for HEDIS
That's Trash! HEDIS requests do not require a signed member consent since the information is processed securely and sent to the patient's health plan for the betterment of member care.
Keep the sample for example! This document has information on every member and measure we're requesting for the office, as well as several ways they can send records.
The office tells you that their HEDIS records are processed by CIOX, what's the code we use? Do they get a fax?
DATA_PP and no faxing please!
This measure would never be considered a duplicate request, even with the same member and measure listed twice.
TRC
Verification notification! This warning will show up on sites until we verify the providers and check the verification box next to the fax number.
Needs DQA
Oh really?? The provider at Atlanta Wellness Group tells you that they have 30 days to return these records.
That's a fact! GA is the only state that has the 30 day requirement if they want to take it, just make sure you add that information to your site action note.
Offices that use the indirect copy service Verisma will be the only ones to receive this letter
The SFTP letter
For the 5 chases at this office the provider wants us to pull records remotely from their EMR tool, oh and they use Healthmark as well...
HMARK_SPHA
Come together! This is the action we would take if an office tells you that they have a central location for processing medical records OR if you have sites with identical information (same address, phone number and fax number).
Just make sure you don't have extra sites selected!
Merging
Who Dis? This yearly medical record review allows us to review Healthcare Effectiveness by using the requested Data Information Set and is the most widely used performance measure project in the U.S.
HEDIS!
We have no way to tell if the chase we're requesting falls under the Medicare, Medicaid, or Commercial health plan.
That's Trash! We can, and should, check the Product column in our request tab to to see which health plan and market we're calling on.
Break it up! The provider tells you that each patient should be on their own separate request, and not grouped together. No problem, you'll generate and fax this letter:
The Individual Requests Letter
This code is used to mark Veterans Affairs Medical Centers before they're moved out to be worked by Special Handling
SPHA_VAMC
Having a blast? This love it or hated process helps us send thousands of faxes out at once, to any sites with verified providers and fax numbers. You'll know it went out on your site by the Target Fax site action on your site.
Our weekly Fax Blast
Our newest abbreviation! SFTP joins the party this year with its own request letter, and it stands for this:
Tough one!
SFTP stands for Secure File Transfer Protocol
The provider is mailing back records but wants us to pay for postage. They say we always email them a pre-paid mailing label for HEDIS records, can we do that?
That's a fact! Just follow your What If and send the site to the correct email box and we're happy to send a mailing label.
Its the final countdown.... This is the letter we'll send in our final weeks, after we've sent all the previous letters, the office is still past due, and only after your manager has given you the go-ahead.
The Final Reminder Letter
We tried! This is your 3rd call to this site: the provider tells you that they will only give us records if someone comes out and picks them up, but they only have 2 chases on the site and are refusing to send any other way.
ESC_ OR ESC_ONSITE since they don't meet the chases minimum