SOPS
TRUE OR FALSE
WHEN TERMING A PROVIDER WE MUST CHECK THE SECONDARY PLATFORMS LIKE I-W-Z SCREEN, YODA AND I-4-Z SCREEN.
TRUE
When adding a provider in CDAT what tab should we (RCL) select to transmit information to Phycon?
Send to Phycon
What agreement ID is Long Term Care agreement ID?
624
How do we determine which Platforms to select in Phycon?
From the products you load for your provider
If provider has no cred info what should we do?
Send for cred
Which sop's instructs DLA's to use the NDB ZIP code Report A4006.
Add to Group
Tin Maintenance Add
Phycon Contract and Amendment
What tool was updated on 07/16/2018?
CDAT
What document will we use to find the AGID's?
Orbit
When do we select "Y" for question, "does the Y line require manual load"?
When we are loading Pulse products.
If provider does not have any cred info and they are a Hospitalist, where would we check to see if Cred is needed?
Credentialing verification SOP, UHN PTI Business rule, RFP grid
If provider Cos Prov type is 0001/0004 you must leave a certain note. Which SOP will you use to locate note?
PHYCON MAINTENANCE SOPS
If the PR was submitted timely, but was not processed due to PPO/RCL issues. Which retro codes should be use?
With approval
R11B/R11C
If Orbit reflects two agreement ID's with same timely filing what must DLA's do?
send clarification
What notes do we need at the PR level when loading a PCP?
PCP ID note and G-role note if applicable.
NOTE:
Provider is a Mid-level, remove Grole from OEB 112 can be found in what sop?
PhyCon Contract and Amendments and
UHC ID Confirmation and Maintenance request.
True or False
When creating PR's, Externally Submitted PR's, Spin Offs PR/Transaction we should click the X on the right side to delete a provider?
False
Only use the check box to remove any providers/group from request to avoid any PR breakage in downstream process.
What agreement ID starts with this: NYHRPROF
626
What note should we leave when loading Medicaid?
(BSAR Note if applicable)
A note at the PR level with the Titan DID number
If my provider has C&S cred only, should I send back to NCC to receive cred for E&I M&R?
No, you can continue to load.
what sop direct you to update the provider directory screen if needed?
PhyCon Provider Add To Group
True or False
When Empire is the only active contract line(s) we must notify the Empire team and submit the request.
False
Notify Empire team through email and attach email to PR/GD and close out the request.
Name one of the specialty's required to load the 624 AGID
Audiology, speech therapy/pathology, physical therapy, certified diabetic educator, occupational therapy, respiratory therapy, podiatry, optometry and oral & maxillofacial surgery
When should we leave the BSAR note on the PR level?
If eff date for C&S is different from the other products.
What downstate market is exempt from requiring C&S Cred?
31531 and Westchester county in 31530