CLM WB

Baskets

100

I've done my research, my group is in CLM. What basket will I use for my demographic load including demo term?

DRM_Demographic

200

I've done my research, my group is NOT in CLM. My TAH is to add new practitioner to group. What workbasket will I use?

PCDM_(region)_NRMM_Load_New_Prac_ADD

300

I've done my research, my group is in CLM. I completed my demo load portion on NDB and I am ready to add to CLM roster. What workbasket do I use to add to deal?

DRM_Contractual

400

I've done my research, my group is NOT in CLM. My TAH is to term my provider. What workbasket do I use?

PCDM_(region)_NRMM_NDB

500

I've done my research, my group is in CLM. I completed my demographic work on NDB and loaded to roster in CLM. Now I must check the contracts loaded correctly. What workbasket do I use?

CMD updates wb

CLM Process

100

According to S1171, what are the search options to find my group on CLM?

1. Emptoris Number

2. Deal Number

3. TIN

4. MPIN

200

When adding a provider to roster, what option does S1171 tell me to choose to prevent downstream errors from occurring?

Upload a spreadsheet containing the roster / Download the current roster

300

I received this roster error: Provider selected is not one of the selected counterparty TINs. What correction is needed? (s1171, Step 11 CLM Roster Validation Errors)

This error is a soft edit, and no action is needed at this time.

400

Why would you receive this error: Provider not found for TIN/MPIN? (s1171, Step 11 CLM Roster Validation Errors)

If a TIN was just added, a new MPIN created, primary specialty updated, or a new UHCID created it will require a 24-48 hour feed.

500

Name the 3 tasks the Market Exception Grid has to choose from.

1. Provider add to K

2. Termination

3. Tin maintenance

Deal

100

How many providers or lines can be updated at one time? (see S1171, Provider Roster hyperlink in Step 10)

Only 200 lines/providers can be updated at one time

200

I completed my load to CLM roster, now I move to CMD. What are the 4 status given by CMD? (CMD Error Resolution Process S1171, step 12)

1. IN PROGRESS 

2. FAILED 

3. SUCCESS 

4. MANUAL-INPUT

300

What is the deal number for MO014 Mercy and Affiliates, LLC?

91259755

400

What columns in the roster can be updated? (see S1171, Provider Roster hyperlink in Step 10) 

Update the pink columns

500

What are the 2 codes used for add and terms in the roster for delegated providers? (see S1171, Provider Roster hyperlink in Step 10)

For delegated providers:

• Use retro code R03 for an add.
• Use retro code R18 for a term.

Bonus

100

True or False. My TAH is to add a new TIN to an existing mpin in NDB. Since the mpin already existed, I can add to CLM roster the same day. 

False. Per S1171, If a TIN was just added, a new MPIN created, primary specialty updated, or a new UHCID created it will require a 24-48 hour feed 

200

True or False. Since my TAH is a specialty update and my provider is already listed on CLM roster, no update to CLM is needed.

False. For a specialty update, in CLM roster we would use term date one day prior to the new specialty effective date and re-load with the effective date on new specialty change. (see Per S1171, Provider Roster hyperlink in Step 10)

300

FNP with supervising specialty or emergency medicine was loaded to NDB by CLM as a PCP. What SOP gives the steps to correct the specialty indicator through CMD?

PCP/SPEC Indicator Override process