Pre-Verification
The pre-verification process comes ___ the detection process.
after
Daily
The GMR specialist reviews claims in the ___ status.
Submitted
In which scenario can you automatically downgrade a member without calling the member?
When a member has taken 2 trips in a downgraded modality.
What do you do when a facility doesn't pick up the phone on the first try?
You call again at a different time.
Pre-verification specialist verifies the ride __ hours in advance
24
How are the members ordered on the Quicksight list?
Highest distance to lowest distance members.
Highest cost to lowest cost members.
GMR specialist reviews rides that equal and/or greater than ___miles.
30
In which scenario will a member be upgraded to AMB even if they don't need assistance and can take a rideshare?
When a member doesn't have a cellphone.
What do you when the facility doesn't pick up the phone for the second time?
Call the member
2) Member going to a facility no covered by the health-plan.
What do you do when a facility doesn't pick up on the second attempt?
You can check Observe AI
What does the GMR specialist do to verify a ride to a non-medical facility (for example - a Grocery Store, Gym)?
Check the ride to the address.
Width > 34 lbs.
If they aren't able to transfer even with assistance.
How often does the detection specialist update their notes?
Every 3 months
What do you do when a member doesn't pick up the phone for the first time?
Call the member again
Pharmacy/Unknown Steven
How does the GMR specialist document rides where the member and the facility were unreachable?
UTR
What is the format of the mobility downgrade note?
DD/MM/YYYY - FWA Confirmed - Your Initials - Mobility Assessment - CSR please only book rides as ‘Downgraded modality’.
How do you verify rides that are non-medical?
What type of trips you can't cancel even if you called the facility and they said they don't have an appointment?
Life-sustaining trip
What do you do when the treatment type doesn't match the Google research?
Call the facility
What department would you ask for if you call a big facility with many different treatment types?
Ask for Billing
Facility first
What is the format for a note that confirms FWA?
MM/DD/YYYY - FWA Confirmed - SH (i.e Your Initials) - Treatment Type – Residential address