HIPAA
What will happen during your call audits if you failed to apply HIPAA?
Means that covered entities may only access, transmit, or handle the minimum amount of PHI that is necessary to perform a given task.
MINIMUM NECESSARY RULE
TMs need to resolve how many tickets per day?
3.6 resolved tickets per Rep per day
How many outreach attempts should a rep make in 5 business days?
3 outreach attempts
If the Email address and phone number matched; we must call the _ and continue with the verification.
requester
HIPAA Privacy Rule protects member's _
Protected Health Information
_ is only valid for the duration of that specific phone call.
Verbal Authorization
What will we do to the ticket when the provider is unresponsive and/or refusing to follow the direction provided?
Resolve the ticket
what ticket priory should we resolved up to 30 business days?
Minor
Provider license number is asked when the provider is _ or if it's a facility
solely Cigna
HIPAA always applies, but if a state law is stricter, what should Oscar follow?
OSCAR must follow the stricter state standards.
If one information does not match on our file, what can we ask as an additional way of verification?
Residential Address
If a ticket is a duplicate of another issue, the issues should be linked/aggregated, and the duplicate should be _.
withdrawn
What is the outreach outcome if we resolved a ticket during a call?
Call Connected
If the provider correctly verified all the information; we must _ their user and registration request.
approve
Email Address is an example of _ identifiers.
direct
OSCAR is a _ as well as other insurers and most providers - physician offices, ambulatory care centers, hospitals, and pharmacies.
"Covered Entity”
Provider Services reps will hold for up to _ before disconnecting a call.
15 minutes
What tool do we use to check for duplicates?
Jira
If we couldn't speak with the requester, we should ask the receiver if they can _ the information on their behalf.
verify
Any person or entity that creates, receives, maintains or transmits PHI on behalf of a covered entity.
Business associate
If PR explicitly gives the middle name but there is none in Rosco, TMs _ as long as first/last names + DOB match.
If PR explicitly gives the middle name but there is none in Rosco, TMs would proceed as long as first/last names + DOB match.
any ticket that’s been open for longer than 30 days. These are tickets that have already passed SLA.
Aging ticket
The tickets will be assigned to you by _
the SME.
What is the callback number when we leave a voicemail?
844-487-0505