CRM
The full name of CRM
Customer Relationship Management
A code used by Major Medical plans to identify a product or service. Used to determine coverage.
J-code (Procedure Code)
Jeremiah's Italian Ice
Mandatory attributes that are required on every call.
Quality Service Opportunity (QSO)
Name the Line of Service when confirming Next Appointment Phone Call Activity
Reimbursement
Reached the person but follow up is needed
Completed - Follow Up Required
On your health insurance card, is a six-digit number that tells the computer database at the pharmacy which health insurance provider is to receive the claim for your prescription.
BIN, or bank identification number
WFO, email for HCP and BCG billing are of this topic
The Past-Training Research Topic
Name our direct QA point of contact
Sara Eisenhauer
Field name to Auto-populates with the HCP’s name
Call To
A medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations.
Current Procedural Terminology (CPT)
A process used to determine if a product and/or service is a covered benefit under the patient's plan
Precertification
It's clear, vital and used everyday
Hand Sanitize
Name the 3 Main Scorecard Categories
Alignment, Accountability and Advocacy
Weeks prior to the next scheduled instillation appointment, the Reimbursement Case Manager (RCM) will contact the HCP to confirm the instillation appointment date
2 weeks
4 type of ways to search for the patient in CRM
DOB, Name, Phone Number, Wild Card
General term that applies to all insurance plans, Major Medical and Prescription Benefit Managers
Payer
It has 9 numbers but 12 buttons
A phone key pad
The amount of calls selected per month for review
4-6 Calls
An email will automatically send to this team notifying them of the change in the instillation appointment.
FRM (Field Reimbursement Managers)
These records are all considered Master Data
HCP Contact record, HCP Location record and Facility Account record
Insurance coverage that is available on addition to any primary policy that an insured may carry.
Secondary Coverage
The date of birth of our AMAZING Leader
April 27th
There are 5 Quality Monitoring Calls Purposes
Direct Trends, Building Relationships, Compliance, Process Improvements and Increase Agent Performance.
Reschedule the Instillation Appointment Follow these steps if the patient states they changed the appointment date.
1. open the Instillation Appointment activity.
2. Change the Start Time to the new appointment date and time.
3. Enter details in the Description field