Insurance
FOR WORK COMP PATIENTS, WHAT ADDITIONAL INFORMATION IS NEEDED FOR THEIR ACCOUNT?
CASE MANAGER AND/OR ADJUSTOR, TPA IF VALID, DOI, CLAIM#
WHERE DO YOU GO TO SUBMIT A FORM LINK SUBMISSION?
On your SOC team page under the front office coordinator library, you can find this under “form links”.
WHAT OPTION NEEDS TO BE CHECKED BEFORE TEXTING A PATIENT FROM RAINTREE?
PATIENT DEMOS – PATIENT COMMUNICATION – PATIENT AGREES
WHAT DOES XXGEN AND XXFED STAND FOR ON THE SCHEDULE?
XXGEN stands for the general hour. You may schedule workers comp, self pay, general, map, and dry needling/wellness plan follow ups/evals on this.
XXFED stands for our federal hour. You may schedule Medicaid and Medicare follow ups/evals on this.
WHAT HAPPENS IF YOU DO NOT COMPLETE FOCUS 15
Pay will be suspended and you will be unable to login into raintree
NAME AN EXAMPLE WHEN YOU WOULD USE FEDNP AS A SECONDARY PAYER
MAP TO FEDERAL
COMMERICAL TO FEDERAL
FEDERAL TO FEDERAL
ANYTIME FEDERAL IS SECONDARY UNLESS TRADITIONAL MEDICARE IS PRIMARY, WE BILL AS TENNESSEE MEDICAID
WHERE CAN YOU FIND THE MAPPING TOOL FOR YOUR CLINIC?
Front page of the source, under people and places.
WHAT DO YOU DO WITH A PATIENTS WALLET IF A PATIENT IS TREATING AT TWO LOCATIONS?
Deactivate the wallet – if treating at two locations, do not save a card on file
WHAT IS SEM AND WHAT DOES IT MEAN?
SEM stands for Schedule Efficiency Model. It means to provide efficient, compliant, and high-quality care while increasing access to the communities we serve. It gives our clinicians the ability to have a well planned out day to ensure they do not feel overworked and gives our oc’s the power to manage the schedule according to our designated templates.
HOW MANY DAYS DO YOU HAVE BEFORE A POC IS CONSIDERED NON COMPLIANT?
30 DAYS
WHERE IN RAINTREE DO YOU PLACE A PATIENTS INSURANCE CARD AND ID?
INSURANCE TAB FOR INSURANCE CARDS AND ID UNDER PATIENT DEMOGRAPHICS
WHERE DO YOU FIND THE START PROGRAM?
Professional Development Page
NAME THREE (3) FUNCTION HOTKEYS YOU CAN USE IN RAINTREE
●F1 – Accessing Raintree help
●F2 – Fastbreak from one area of the program, go to another and then return to the
●original place.
●F3 – Temporarily leave the Raintree Program, access another program and then
●return to Raintree.
●F4 – Lock workstation, Log out or select another database.
●F5 – Access the Raintree Calculator
●F6 – Add Raintree Quick Keys
●F7 – Print / View Options
●F8 – Review System Information
●F9 – Access Raintree E-mail
●F10 – Save data entered into the Raintree Program
●F11 – Unshadow a user
WHAT ARE THE STEPS AND CODES TO BLOCK A THERAPISTS’ SCHEDULE IN RAINTREE?
Right click and highlight the area needed to reserve time on the clinicians schedule and use the OUT, MTG, or ADMIN codes. You can also leave a comment down in the box to give a description as to what the blocked out time is being utilized for.
WHAT STEPS SHOULD YOU TAKE WHEN YOU SCAN INCORRECT PATIENT INFORMATION INTO ANOTHER CHART?
IT Ticket – I’m facing an issue – HIPPA privacy – Select Scanning Errors/ Duplicate Accounts
WHAT INFORMATION IS NEEDED WHEN EDUCATING BENEFITS TO PATIENTS?
CO INSURANCE OR COPAY, DED AMOUNT, DED MET, PATIENT RESPONSIBILITY
NAME FOUR (4) GLOBAL ABBREVIATIONS YOU CAN USE IN RAINTREE
●1a
○1st Attempt. Called MD office to verify fax # and request POC to be signed and returned. Spoke with @@ on <date> at <time>.
●1lm
○1st Attempt. Called MD office to verify fax # and request POC to be signed and returned. Left message on <date> at <time>.
●1rr
○1st Attempt. Called LM for patient on <date> at <time>.
●2a
○2nd Attempt. Called MD office to verify preferred method of communication and request POC to be signed and returned. Spoke with @@ on <date> at <time>.
●2lm
○2nd Attempt. Called MD office to verify preferred method of communication and request POC to be signed and returned. Left message <date> at <time>.
●2rr
○2nd Attempt. Called LM for patient on <date> at <time>.
●3a
○3rd Attempt. Called MD office to verify status on the signed POC and request POC be faxed to the clinic as soon as possible. Spoke with @@ on <date> at <time>.
●3lm
○3rd Attempt. Called MD office to verify status on the signed POC and request POC be faxed to the clinic as soon as possible. Left message on <date> at <time>.
●3rr
○3rd Attempt. Called LM for patient on <date> at <time>.
●A1800
○Verbal consent for 1800 notify
●aremind
○“verbal consent for reminder messages”
●D1800
○Declined verbal consent for 1800 notify
●dremind
○“declined verbal consent for reminder messages
●Dup
○Duplicate account without linked items. Requested account removal. Please use account @@.
●Dup1
○Duplicate account with linked items. Account marked inactive. Please use account @@.
●ietext
○@@[OC enters Brand]: We look forward to seeing you today at @@ [OC will enter time]. Please remember to bring insurance card and prescription and your mask. If you have any questions please give us a call at @@ [ OC will enter phone number].
●latetext
○@@[OC enters Brand]: As a reminder we had you scheduled for an appointment at @@ [OC will enter time]. We would like to keep your appointment today. Please do not forget to bring your mask. Please give us a call at @@ [ OC will enter phone number].
●sietext
○@[OC enters Brand]: Esperamos verte hoy en @ [OC Will enter time]. Recuerde traer su tarjeta del seguro, la prescripción médica y su cubrebocas. Si tiene alguna pregunta, llámenos al @ [OC will enter phone number].
●slatetext
○@[OC enters Brand]: Como recordatorio, le habíamos programado una cita en @ [OC Will enter time]. Nos gustaría mantener su cita hoy. No olvide traer su cubrebocas. Llámanos al @ [OC will enter phone number].
●Lmva
○Faxed lien to attorney <today>.
●MISIN
○Insurance not in Raintree submitted survey submission
●MISMD
○MD not in Raintree submitted survey submission
●MISPR
○Professional contact not in Raintree survey submission
●NDC
○One Call Portal Request: Will patient be continuing therapy or is patient being discharged? Have Discharge Summary complete if appropriate. Please respond back to task.
●noins
○Patient refused to give health insurance
●NOSH
○Informed patient of cancelation policy and fee of $30 if 24hr notice is not given.
●NPN
○One Call Portal Request: Progress Note needed. Please respond back to task when completed.
●PLAP
○Changed Insurance per OCs request
●PT48
○Patient scheduled outside of 48 hr due to
WHAT IS THE DIFFERENCE BETWEEN A TRADITIONAL MEDICARE VS A MAP PLAN
Traditional Medicare is the normal red white and blue card. A MAP plan is Medicare combined with another insurance in the card.
WHO IS RESPONSIBLE FOR SCHEDULING INTERPRETERS AND WHERE DO YOU FIND ADDITIONAL INFORMATION
THE CLINIC IS RESPONSIBLE FOR SCHEDULING THIS AND ADDITIONAL INFORMATION UNDER QUALITY ASSURANCE
NAME FIVE (5) INSURANCE PLANS WE CONSIDER TO BE FEDERAL PAYORS
MEDICARE, TRICARE, UHC COMMUNITY PLAN, BLUECARE, AMERIGROUP
WHEN LOADING PATIENT PAPERWORK, WHAT CATEGORY DO WE CHOOSE FOR PHI FORM?
You will use the category “Miscellaneous” and rename it “PHI”.
WHAT APPOINTMENTS CAN BE SCHEDULED IN ANY HOUR SLOT WITHOUT IMPACTING BILLING GUIDELINES?
Skilled Training, Dry Needling, Work Conditioning, FCE
WHAT INFORMATION IS NEEDED WHEN AN AUDITOR COMES TO YOUR CLINIC AND WHAT DO YOU DO?
ASK FOR IDENTIFICATION THEN REPOR IT TO CLINCAL SERVICES FOR TRACKING