CMF
CMF Phone-subtagging selection for cases that cannot be found in the portal
MEMBER NOT FOUND
What will be your sub-tagging for IPA tasks? (next step detail)
Other
Statement in the auth task if the NPI and Tax ID are not available.
No information on file
Blue Cross Blue Shield Eligibility Line Phone Number
800-676-2583
Portal Issues Workflow
Portal Tab
CMF Phone-subtagging selection for surgical codes not found in the portal
PROCEDURE NOT FOUND
What is the tagging if authorization is approved but DOS is not covered by the effective dates?
Approved
If the facility's NPI is not listed in the auth task, what are our resources to locate the missing information?
If a payer tells you that they don't assist third parties, what will be your first pushback?
Push back that we are contracted to obtain precertification on behalf of the doctor's office.
IPAs
Additional Task Resources tab
CMF selection for after getting an approval through 'Update-Case tpa' link
WIDGET
How will you tag the requisition if you are working on PDOS task and case is still pending with no additional information needed?
Follow up with Payer
If the facility's Tax ID is listed in the auth task, what information should you locate in our resources?
NPI
This is the preferred method of contact to the payer following order of operations
Widget
Initiating Without Clinical Available
Clinical Guidance Tab
Kyrie initiated a case through the portal. The case got pended and the DOS is today's date, hence, he contacted the payer via phone to follow up on the case, however, the office is currently closed. What is the most appropriate CMF?
PORTAL
What is your denial reason when the payer is unable to make a decision based on a lack of clinical information?
Not enough clinical information
This is the facility information available which allows us to attempt to obtain precertification without calling the facility.
NPI
Number of attempts for follow-up after successful initiation of case when payer is unreachable before task is escalated to US Team
3
Missing NPI/TAX ID
Additional Task Resources
Gordon called Carelon to verify precertification requirements. Per payer, the member cannot be found in their system. He then called Cigna to verify the details further and was also advised that the member does not exist in their system. What is the most appropriate CMF?
PHONE
What is the tagging if you call the facility for missing NPI information and facility informs you they do not do the procedure listed?
Needs Practice Attention
NPI and Tax ID are not available. Which one should you document in your task if both information were asked by the payer and are available in our resources?
NPI and Tax ID
CP 1 - Payer is unwilling to speak with TPA.
CP 2 - Initiated a case through phone.
CP 3 - Payer is unwilling to speak with TPA.
What should be your tagging (CP 3)?
Payer not reachable, try again.
All Procedures Except Inpatient
Procedure Specific Resources Tab