Pre-verification
Google the ride to address.
Top 4 treatment types that are associated with fraud.
1) SUD
2) Pharmacy
3) Specialist
4) PT
We only review rides over ___ miles when looking at GMR trips?
30
When do you would upgrade a member to Stretcher even if they can physically take a wheelchair?
When the member has steps
What is step after you have found the phone number on Google?
Call the Facility
How often do we download the Pre-Verification QS sheet?
Daily
How often do you download the Quicksight sheet from the detection dashboard?
Daily!
What department would you want to be referred to when you reach a big hospital system?
Billing Team
What is the format for the member downgrade note?
DD/MM/YYYY - FWA Confirmed - Your Initials - Mobility Assessment - CSR please only book rides as ‘Downgraded modality’.
What are the 3 culture P&C pillars?
1) Mission-driven approach 2) Accountability 3) Continuous Improvement
What do you do when a member gets upset at you for canceling rides?
Stay calm.
Hold your ground.
Focus on the future.
Research observe AI
What is the ideal tone when you're on a call with a facility?
1) Calm
2) Sense of Urgency
3) Having all the information you need on hand
What scenario would you downgrade a member without calling the facility or member?
If they have taken 2 trips in a downgraded modality.
How to flag the member?
Going into General---> Mobility Assessments --> 'Flagged Member' box.
You make a note and call the facility again.
How do you make sure you're not reviewing members who already have notes on Excel?
Filter the FWA notes to ensure you only see the blanks.
If you can connect with the facility but they cannot give you the information you need at that time. How do you document that on the 'Detail Notes'?
'Attempt Number'
What are the 3 reasons you would upgrade someone to AMB even they are able to take Rideshare?
Distance over 30 miles
Member doesn't have a phone
Area doesn't have rideshare coverage
Rearrange these modalities from most expensive to least expensive.
Bus Pass, GMR, Rideshare, AMB, WCV, WCX, Stretcher
How do you know if a member is eligible for a specific treatment type?
You can go to ride booking view and check if that treatment type shows up on the drop down menu.
If you reach the automated system on Pharmacy, how would you navigate that?
Press button for Provider
What is the last step in documenting if a member's claims are denied?
Flag and make a note on the member's profile.
What do you do when you downgrade a ride within 24 hours?
Let TransOps know
Why does the P&C team do what we do?
To help those who truly need to get to care get to care.