The Legend of the Missing Practitioner (PMV/PMT)
No longer with the group/TIN entirely.
What is PMT?
A receiver says the practitioner is retired. Before selecting a disposition, agents must first ask this follow-up question.
What is "Is the practitioner fully or semi-retired?"
Outbound agent asked the effective and expiration date of the board certification and did not leave notes.
what is failed to do websearch?
Fully verified and completed record
What is CVA?
Indicating state compliance and required elements including enriched elements
What is State Rules?
The practitioner is not at the location being validated but is still affiliated with the same TIN.
What is PMV?
Receiver is requesting to add internal medicine.
What is "Is the practitioner seeing Cigna patients for Internal Medicine"?
Group has been bought out, receiver provided new TIN and it is not in the Masterfile. Agent updated TIN without required documents
What is failed to request w9?
TIN that needs validation before terming
What is PND?
California Campaign Exception. DO NOT tag as Not Verified – Bad Phone Number. Dispose as Retry – Other instead.
What is Call handling?
This disposition should never be used when processing a termed practitioner record.
What is No – Retired?
Receiver said NO to HMO.
What is "Is the practitioner not accepting new patients for HMO or are you not contracted with HMO at all?"
Agent failed to include web search documentation for ABMS.
What is "Agent failed to document the interaction"?
Receiver asked to be on the DNC list, and does not want to verify over the phone or email
What is Provider Refused?
No fax verification.
What is Outreach Calls?
This termination process will only apply for all termed practitioners or addresses/locations in the state of Illinois. There will be separate processes depending on the verification channel.
What is IL Term Process?
Address on file is already closed, the receiver provided a whole different address within the state.
What is "Is the address still under the same TIN?"
Following a confirmed "Not Contracted with Cigna" response, agents must provide the receiver with information for this Cigna department.
What is the Provider Service Unit (PSU)?
All groups that will be processed by Cigna
What is excluded?
PLU and Campaign Ops Manager Links
What is Home?
Verify if they are seeing patients or directly supervising practitioners.
What is supervising practitioner?
The receiver is unsure of the panel status and hospital affiliations.
What is "Is there someone else who can verify this?"
Outreach stopped per client instruction
What is invalid data?
This is done to OBTAIN A NEW PHONE NUMBER for the provider/location we have on our call app when a call is unsuccessful.
What is Web Search Guidelines?