Authorizations
How can you tell if a patient requires authorization?
PreAccess Benefit Memo, Patient Insurance Alerts, Scheduling Matrix
How do you access the WQ section?
Where do you find a therapist's schedule request?
Active Request tab
What is the process of seeing a patient without a referral for up to thirty days?
Direct Access
What is it called when a patient walks in to schedule an evaluation?
Intake
What insurances require a worksheet to submit for authorization?
Oscar, Wellcare, Sunshine CMS
What button do you hit to alert the auth team that you have completed pending items needed for submission?
What appts can you not double book?
reevals, evals, neuro, transfer, before an eval, back to back
What is the process called when a PBR would need to add a physician not in the system?
Provider on the fly
Process of chart prep for next day new appts.
Eval Prep
How long should you wait to follow-up on a POC required for authorization?
Two days
What WQ tab would you access for patients needing authorization?
Patient tab
What is the maximum double books you can do in a day for a full time therapist?
What is the process you would use if a patient has not shown to their appt after 15 minutes?
EOD Process
Place where you can find benefits from PreAccess.
Umbrella
3 days
What WQ tab would you look under for patients needing scheduling (follow-ups and evals)?
Referral/Authorization
When can you use an eval slot for a follow-up?
24 hours prior
What is the process when a patient has an insurance change?
End date the insurance, create new HAR, create new referral record
Notifications for clinic staff on insurance exclusions.
What is needed to submit for auth for the following insurances:
Simply, Sunshine, Wellcare, Oscar
Simply: signed POC, Sunshine: Signed POC, Wellcare: Evicore form, Oscar: ASH worksheet
What WQ number is it for auth database?
31851
How many appts seen does it take for a full-time therapist to be productive?
14 appts
What is the self-pay discount process?
Opting out of insurance: 40%, patient true self-pay: consumer rates, patient maxed benefit limit/insurance excluded: consumer rates, Orthotics/Audiology: 79%
Authorization