Member/Responsible Party
3 pieces of Primary Information for Verification
What is Member ID, Name, and DOB?
The four primary pieces to verify a provider
What is Name of Caller, Call back number, NPI, and Name of facility/provider associated with NPI?
The location to view additional persons with authorization on an account
What is the Care Team screen?
This list shows state case workers for Michigan
What is the HLO list?
What is full address, phone number, or last 4 of SSN (MI Only)
Secondary Pieces used in place of provider NPI
What is provider/facility address?
3 primary pieces to verify person in Care Team
Pieces of verification for an HLO worker
What is Full Name, Phone Number, and county?
If a provider does not have NPI and we are unable to locate in MCS, what information can we use to verify?
What is the provider's address through Google search?
Example: Dad is calling for child, Mom is listed as RP and Dad is not on account. What is best practice in this situation?
What is ask if Mom is available to add Dad to the account?
Example: We must call out to provider's office to schedule an appointment for a member. What information is needed from the provider to schedule appointment?
What is Name of person we spoke to, name of provider/facility, NPI, phone number we called
We can assist care team members that show this status
What is "Active"?
Information HLO worker can receive on a Foster Care account
What is all information?
Pieces of information to verify TPL insurance
What is name of representative, phone number, name of insurance
Scenario: Mom calls in for child, we notice mom has an attached account that is active. What is best practice to proceed?
What is ask for Mom's full name, DOB, and ID number?
2 primary places to verify provider's information
What is MCS and NPI Registry?
Verbal PHI Access is authorized for this many days
What is 14 (calendar) days?
Places to view authorization of a case worker
What is HLO list, Fostercare tab, and Care Team?
This piece of documentation is recommend offer after adding a person to the care team
What is HIPAA Authorization form?
Scenario: IL Member does not have ID number, verifies name and DOB. Address and phone number do not match. The address listed in the RP tab matches what the member gave. Can this be used as a piece of verification?
What is No?
A provider needs the member's ID number to schedule an appointment, what is the best practice to assist?
What is fax eligibility?
If there is no individual listed on the member's account as a parent or guardian, what 2 pieces of information can we use to add caller to care team?
What is matching last name or matching current address?
This resource is used to verify all caseworkers when we are not able to verify through the HLO list or on the member's account
What is the State Employee Directory?
Scenario: IL member, program code TANF, informs us that she is pregnant during HRA. Best practice to proceed?
What is complete the HRA, then ask if they have had first prenatal visit? If yes, transfer to Care Coordination for additional assessments.