This department receives checks, claims, ADS responses and applications.
What is Process Control?
100
Caller is discussing subjects that are not classified into the defined categories or subcategories.
What is General information/other issues?
100
Approves PTO, timesheets,exceptions and provides annual performance evaluation
Who is Angela Honeycutt?
100
DPLS
What is date patient last seen?
200
Date of birth, last name, first initial and HICN
What is needed for beneficiary authentication?
200
This department processes invoices, Medical records and ADS responses.
What is Medical Review?
200
Caller is asking for information related to other insurance coverage that the beneficiary might have that is primary to Medicare.
What is Eligibility/MSP Record?
200
Handles blue pumpkin, forecasts ASA and schedules
Who is Chris Hatcher?
200
DSMT
What is Diabetes Self-Management Training?
300
Provides accurate information, takes correct action needed to resolve issue and corrects any inaccurate information given during the call.
What are QA accuracy requirements?
300
Don't send a suspended claim question to Claims/Suspense if Medicare isn't primary, you better send it here instead.
What is MSP?
300
Caller is asking for information on a claim that is covered by a supplemental insurer, such as Medigap or other private insurance
What is Claims status/crossover?
300
Orders supplies and other administrative tasks
Who is Anah Knight?
300
ESRD
What is End-Stage Renal Disease?
400
This portion of the QCM scorecard divides the call into six specific Performance Criteria that address how well the CSR interacts with the caller. It allows assessment of how well the CSR demonstrated the skills listed.
What is Customer Skills?
400
This department handles electronic claim submissions, front end rejections and Pro-Ace inquiries.
What is EDI?
400
Caller is asking the reason that payment was withheld or for an explanation of the FCN.
What is Financial/offsets?
400
Patrols parking lot daily and monitors daily entry into the building
Who are the security guards?
Mr. Robert
Mr. Henry
Mr. J. R.
400
IDTF
What is Independent Diagnostic Testing Facility?
500
Name three of the six QCM Customer Skills?
What are...?
1. Opening
2. Professionalism or Tone
3. Listening Skills
4. Communication Skills or Language
5. Holds and/or Dead Air
6. Closing
500
Cost Reports, Credit Balance Reports and PS & R Reports
Who is PAAR?
500
Caller is asking about the COB contractor responsiblilities and contact inforamtion. Includes situtations that require a referral to the COB contractor.
What is MSP/COB?
500
Overseer of Cahaba and communicates directly with CMS
Who is Sherrie LeMier?
500
MPFSDB
What is Medicare Physician Fee Schedule Database (MPFSDB)?