Test my luck
Minimum required payment for 1099?
$600
RD requests increase; says other plans raised rates.
Provide RD decline script
What does a provider is responsible for maintain an loa status?
Maintain their professional Liability
Mainti their licensed
Comply with the re credentialing process.
What is a Termination?
Termination is when ASH terminates the practitioner from the ASH network
Can we Retro an effective date ?
ASH does not backdate due to Health Plan reporting requirements, except under special circumstances approved by management.
Scenario: wants 1099 to new address, must submit?
W9
A provider says the Health Plan has a different TIN and NPI listed for them. What is the correct action?
Collect the incorrect HP data and effective dates & submit a HP request
How can a provider enrolled in Medical on CA?
•Enroll on the Department of Health care Services (DHCS).
•Acupuncturist can submit the ASH-Medi-Cal Enrollment form found on ASHLink.com.
•Providers should not be on an exclusion list.
•Providers must submit a Disclosure of Ownership (DOO) form annually.
If the Provider is terminated for not supplying ASH with their malpractice renewal information?
they may be reinstated if it is not past their appeal date.
What is CPS?
•The Clinical Performance System (CPS) is designed to ensure high quality and efficient care through appropriate clinical oversight. AKA Tier level
How many days to process a PSCR-form?
7-14
A practitioner calls after receiving a letter stating their malpractice has expired. You check Promis and see the malpractice is past due. What should you instruct them to do?
Email their updated malpractice declaration page to malpracticeins@ashn.com
How can provider enroll in Medicare?
•Must enroll with Medicare through CMS.gov.
•They should not be on an exclusion list.
•Must submit a Disclosure of Ownership (DOO) form annually.
ASH Lines of Business?
Comercial plans
Medicare
Medicaid/Medical
Name the PSCR-form that can help the provider update his email?
PSCR-form Contact info
What to verify before sending 1099 request?
Office is calling because the provider no longer works at their office.
Take info
Send to PRL bucket as MIA or UTL
Providers may opt out of a specific Health Plan under what circumstances?
During recruitment Within 30 days after issuance of a new client summary
45 days in California
During the 4th quarter of each year (October 1 – November 15)
Only in certain circumstances will ASH approve a timeframe waiver; manager approval is required
What are some of the reason why a provider will be terminated?
•Failed to provide malpractice insurance,
•Licensed expired
•Unable to Verify (UTV)/Unable to Locate (UTL)/Missing in Action (MIA)
•Clinical reasons
how can a Rehab group add and remove provider provided the steps?
Fill step 1 ( group info )
add letter P
Remove Q
Step 4 group manager or owner
Where on the client summaries an office can find claims submissions?
under claims section
Office is upset and is requesting to speak to a manager because their claims are being denied - HP told the office they are not part with the health plan.
Check iNN status
Check online directory
Transfer to CSS if needed it
Evaluated what type of cap Administrative /Clinical
Provided direction/education
If PT that is already credential with ash gets added to another group would they received a welcome letter?
NO- we only provided welcome letter on their initial credentialing.
What topics' did you discuss during the provider orientation?