Verifications
The first step you can take to quickly resolve when a patient's insurance returns with an error or red exclamation point.
What is clicking the verify button?
The key items you should always get when placing a call to the insurance company for authorization requirements.
What is the name of the representative, the reference number, if authorization is required, and where to obtain authorization?
The greeting you say upon answering the phone.
What is IVT, this is ______ speaking how may I help you?
The codes you should be prepared with before calling an insurance company to start a case.
What is the ICD-10 or CPT code?
The policy that prevents us from giving personal information to someone other than the patient.
What is HIPAA?
The place/button you click to change which insurance is primary vs. secondary.
What is the green up and down arrows?
The items you notate when an authorization is on file.
What is the authorization number, the site, the cpt code, and the expiration date?
The process you take when the patient needs to schedule a new exam.
What is transfer the patient to the main scheduling line?
The two "branches" of EviCore.
What is Medsolutions and Carecore?
The resource you utilize when you come across an insurance you have not dealt with yet.
What is the insurance grid or IBSR folder?
The button to remove a screenshot you scanned in accidentally before saving the account.
What is click the button with the red "X"?
The number of eFaxes we send before calling a doctor's office.
What is 1?
The body language that a patient can hear over the phone.
What is a smile?
The process we follow when an authorization is denied.
What is call the physician to see if they wish to do a peer to peer or cancel the appointment and call the patient to notify them of the denial and cancel the appointment?
Exams that you should not touch.
What is physicians that are marked in red?
The two general things you are looking for when checking a patient's insurance policy on a portal or calling.
What is eligibility and benefits?
The process to follow when the scheduled exam and the authorized exam do not match.
What is check if a script is on file and if not, call the referring physicians office for clarification on what is ordered?
The process you take if someone calls in regards to an account that someone else is already in.
What is speak with the person who is in the account to determine if they should take the call or exit the account?
The areas in RIS that you put your notes.
What is IVT (Verificaion/PreCert) Notes, (Order Notes if MD), eligibility override, and the contact log?
The areas in RIS that provide valuable clinical information to assist in obtaining an authorization.
What is the reason for exam field, the scheduling notes, attached clinical notes, the script, pathology, and/or previous RadNet imaging?
The section you can find the patient's MCO or Medicare advantage plan after clicking on the yellow question mark in RIS.
What is the providers and/or plan section for Medicaid or the Part B section for Medicare when clicking on the yellow question mark?
The process you take to find if Aetna requires authorization.
What is check MedSolutions, check CareCore (if NY), and call Aetna to ask if the group has opted in or out of high-tech radiology if they do not populate?
The process to follow if a patient is irrate on the phone.
What is remain calm and positive with the patient, reach out to your group leader, team lead, or manager for assistance?
What to do when a patient is scheduled for a CT Lung Cancer screening (G0297), but has a cough.
What is email the scheduling department to advise them that the patient does not qualify for the screening and to change the code to 71250?
A deductible.
What is a specified amount of money that a patient must pay before their insurance company will pay a claim?