RAINBOW RUMBLE

A

1

What is the Physician calling hours? 

9:00 am - 12:00 pm and 1:00 pm - 5:00 pm following the MDO Timezone

2

What will show in the hub when the bot has the account checked out? 

R1 Automate

3

Using the Master Payor guidelines in Knowledge Center, What are the Four Types of Insurance Plan? 

HMO, PPO, POS, Indemnity

4

Which tab in R1 Clear we can input the services and procedures? 

Service Tab

5

It is an approval from the Payer for a service to be rendered? 

Authorization

B

1

In Physician Contact, MDO needs to be contacted regarding which authorization statuses? 

Auth Not on File, Pening or Denied

2

Using the Master Payor guidelines in Knowledge Center, What are the 3 ways to verify eligibility of Aetna? 

1. Run Query 2. Check Payer web 3. Call Payer

3

Using the Insurance Card Image Library, what is the plan code of Aetna Better Health, facility is Pensacola

590700000

4

Using the Insurance Card Image Library, Is United Healthcare In-Network with Austin Seton Medical Center? 

Yes, In-Network

5

This Authorization Term means that No Authorization is required (NAR). 

Suppressed

C

1

It is a guideline that ensures legal, ethical and professional standards are met. This maintain a highest qualkity standard of care to protect the patient's information

Compliance

2

What are the 3 possible outcomes after Run Query? 

Passed, TBD, Failed

3

When contacting the MD’s office to request authorization, when should you request to have the auth secured?

By 5:00 pm two business days before service

4

What is the tittle of the Knowledge Center Article where we can find the Exception Message 

R1 Clear Exception Messages

5

PHI Stands for? 

protected Health Information

D

1

________ supersedes normal work queues (per the ministry) and takes effect one business day before an R1 observed holiday. 

Holiday Work Queues

2

_________ is a telephone conversation between the ordering physician and a physician who works with the insurance company

Peer to Peer or P2P

3

This is the percentage of costs the patient pays after meeting their deductible

Coninsurance

4

True or False: If using the disposition Obtained Authorization/Referral, Needs to Verify, you can complete the Authorization tab.

False

5

If leaving a voicemail when contacting the MDO to request authorization, what Activity and Disposition you need to use?

Authorization/Referral Request 1,2 or 3 and more

E

1

This is the maximum number of services or dollar amount the insurance will cover within a year or designated timeframe; this usually refers to a certain service performed only once a year, such as a mammogram.

Limitation

2

When calling a physician or patient, you must always say that you are on a __________ line

Recorded

3

A __________ will help send emails and faxes for 3+ Days out.

Bot

4

The three methods of contact are email, fax and __________ .

Phone

5

True or False: The health plan pays 100% after the out-of-pocket maximum is met.

True