Pre-Process Training
Whom do we refer to as Providers in US Healthcare system
Facilities, Clinics & Nursing Homes
What is Verification ?
The process of calling Provider's Office/Facilities to verify necessary information in order to send the MRR
What is unobtained status ?
When we are unable to reach a live person or obtain any information/Request status from Provider's Office or Facility
Which are the 3 P's in US Healthcare System
Patient, Provider and Payer
Which are the 4 Minimum Required Information for a successful verification call
1. Provider/Facility Name
2. Physical Address
3. Fax #
4. Request Mode
Mention any 5 scenarios of un-obtained status while outreaching Provider Office/Facility
Office not open
Office is closed for lunch
Office is closed for the day
MR Person/POC is on leave, out of office or busy
Phone line rings for extended period
Line is busy
Reaching VM
Left on hold
Someone answers and ask for a callback
Who are eligible for Medicare Health plan
- Elderly people of the age 65 & above
- Physically disabled people
- People with long term diseases
What is Request Mode ? Which is the most preferred Request Method
How Provider Office/Facility would prefer Advantmed to send the MRR.
Fax is the most preferred
Which are the scenarios for Data Research
When IVR says that the Number is disconnected
When the IVR says that the number is out of service
When we reach a personal number of someone who is not in medical records, or Dominos, McDonalds
When there is 3 unobtained on 3rd business days
Difference between Medicare and Medicaid
Medicare - For elderly people 65 + age/ people with physically disabled/people with long term diseases , funded by Federal Govt., has 4 parts
Medicaid - People with limited income and resources, funded by federal and state govt.
What is collection method? Mention any 5 Collection Methods.
Collection Method - How the Provider Office/Facility would send medical records to Advantmed.
Upload/Fax/Email/Mail/Onsite Scanning/FEDEX/Copy Service/Remote Download3 scenarios when we have not reached correct phone # to obtain medical records
# Out of Service, Wrong # and Disconnected #
What are the 3 Types of Audits and when do they take place
HEDIS - Feb to May 10th
HCC - June to end of Jan
RADV - Sept/Oct to March
Explain 3 Types of Verification
Partial Verification - All minimum required information is not gathered
Verification Done - All minimum required information is gathered but we do not have approval to send MRR
Send Request - All minimum required information is gathered and we have approval to send the Request
When we dial on the phone # and the POC states that they do not have the asked Provider in staff, when will we move the case to Data Research
- When they do not have patient's records after verifying with complete details.
- Providers other location's contact information