Authorizations
For admission, this retro auth is only allowed for inpatient stay.
For Inpatient:
What is direct admission or emergency?
This SOT states, the advocate should be sure to use a friendly and inviting tone using inflection and mannerisms.
What is the SOT - Guiding Principles - Advocate Contact Handling OneSource - Tone and Inflection - KM1813451?
This item stating the answer is hard to locate when the advocate is on the call.
What is the SOP?
click the mute button.
Provider calls for requirements for an auth, this is the main thing needed to check to see is auth is required.
What are codes?
This SOT states, advocates should clearly explain the portal’s specific features and benefits, such as checking claim status, submitting reconsiderations, uploading authorization documents, and verifying member information.
What is the Advocate Contact Handling OneSource - KM1959201 - UHC Provider Portal Education Tool?
(2 part question)-
1.This box on a 1500 claim form is where the clia id is listed.
2. This is what CLIA stands for.
What is box 23?
What is Clinical Laboratory Improvement Amendments (CLIA)
When a provider is frustrated, advocates should use what skill (emotion) before jumping into solution.
What is empathy?
Researching info, I use the hold button and it is located here.
What is the hold button on Genesys?
This is where you find description of codes so you can better understand what type of procedure the provider is asking about.
What is Knowledge library?
This SOP states For Calls: The advocated must promptly provide their greeting - without hesitation or delay. Chats: Greeting must be within 30 seconds of connecting.
What is the SOP (KM1813502) Contact Opening and Validation - Advocate Contact Handling OneSource?
1500 claim forms are processed under this provider.
What is the rendering provider?
All of us advocates treat each provider with this, regardless of the situation.
What is respect?
I gave the incorrect info to the provider. The call has now ended, and I will have to do this.
What is a call back?
This is the required when sending in a request to change provider or facility on an auth?
What is auth inquiry?
what is template?
This SOP states, if it is going to take you more than a few moments (30 sec), to find information, ask the HCP if you may place them on hold for 2-3 minutes, then be sure to check in/return before those 3 minutes is up.
What is Utilizing Hold vs. Mute - Advocate Contact Handling OneSource KM1814250 Terms & Definitions - Advocate Contact Handling OneSource KM1814650?
This is the correct process to help a Provider that has 22 claims that denied for same reason and same member.
What is a claims project?
This skill allows advocates to type notes, review benefits and listen at the same time- while keeping the time on call or chat at a minimum.
What is multitasking?
This is the provider side website.
What is viva-engage?
Viva Engage - Rose Provider
This specialty auth is not created by us and will need to be transferred or redirected.
What is a behavioral health auth?
This SOP states, the advocate should be sure NOT use the phrase or phrases "As I stated earlier, and/or as I just stated a little bit ago" as this can make the provider feel like you are annoyed or not wanting to help.
What is SOT - Guiding Principles - Advocate Contact Handling OneSource - KM1813451?
Whis claim status processing code means the claim is closed.
What is 99?
This happens when an advocate finds the answer after opening ONE SOP.
What is winning the lottery?
This is used to ensure the member’s plan type is verified before servicing the call/chat.