That's a Red Flag
The Claimant's address is in VA and they were seen 7.6miles away at a facility in NC
A call
What is when you get an answer from a facility: anything other than Multiple attempts or Line is not in service
Line not in service.
Line is not in service.
The contact asks you if the claimant said they were seen at the facility
We are performaing a radius search on behalf of their adjuster to verify whether they are in your system
When NPI #s are used
What is on hits and blank profiles?
The hospital says that the Claimant had an inpatient stay from 08/01/2023-08/12/2023.
What is a blue 4 flag?
Dashboard
The OD system where you get your cases
Facility confirmed the Claimant has a profile, but no service dates.
Facility confirmed the Claimant has a profile, but no service dates were located.
This is a worker's compensation case so it doesn't fall under HIPAA, are you able to tell me if the claimant was seen at your office?
The main difference in the SIU summary for flagging from Non-TRA cases
What is instead of counting each flag, each hit with a flag is counted?
The Claimant's loss date is 05/01/2023. There is only one hit for the specialty, a partial date of service for 04/2023.
What is a red 1 flag?
Any date of service, "Claimant has been seen", "Records not accessible", "Prescribing/referrring physician is affiliated", profile created/edited
Facility can view records for all pharmacies.
Facility can view records for all PHARMACY NAME pharmacies.
Have you sent in a release of information?
I don't know if the adjuster has already sent in a release but are you at least able to verify the claimant is in your system?
How to find the NPI # (2 answers)
What is ask the contact from the facility and google the facility (makign sure name and address matches)?
The Claimant's provided name is James Maldonado. The contact says his DOB and phone number pulls up a "James Maldonado Jr". The address doesn't match and they can't search by SSN.
What is a black 5 flag?
A Blank Profile
"Facility confirmed the Claimant has a profile, but no service dates were located." Not a hit
BONUS! Pharmacy blank profile "Facility confirmed there is a profile for the Claimant, but the records are not accessible." a hit
Facility will not release any information without a request for medical records.
Facility will not release any information without a request for actual medical records.
Are you the adjuster?
No, I'm calling on behalf of the adjuster/their insurance company to verify that the claimant has been seen
Where in the SIU summary would you put a hit for a prescribing doctor who is a cardiologist
What is under "Other"?
There are two hits for orthopedics and 1 hit for a separate chiropractic search, all 3 locations are in the same state and less than 10mi from the claimant's address.
No flag can be used with this information.
Split city
What is when the client requests a search in 2 or more different areas?
Facility will not release any information without a request for actual medical records.
Facility will not release any further information without a request for actual medical records.
What is the date of service you're looking for?
Our loss date is ___ so anytime around that date would be helpful
What is under the other city (after checking that the prescriber isn't already on the report)?