OneSource Basics
This ISG tool is the primary source for job aids, SOPs, and standardized guidance.
OneSource
What is the SLA for PRISM SME RP?
2
Who handles load validations for physicians?
ERC
What kind of jargon should we always avoid with the provider in our communication?
Internal Jargon
What SOP would I be able to locate that the correct PID was selected on my claim?
State specific Provider Selection SOP
What step of the OneSource would require you to send an acknowledgement letter?
Step 3
What kind of ticket is submitted when wanting a review from MCR/Clinical Med Nec - C&S RP?
Macess Service Form (SF)
Who handles rate validations for facilities?
PCRL
What is our teams new structured workflow?
follow ups, tasks, new cases
Where in My Metrics can I view my goals and metrics?
Under Performance Summary
What is the percent of claims required for samples and what is the minimum case item sample?
10% with a minimum of 10 claims
What RP would you submit to for benefit related issues?
BCO/BCCS
Retrigger via Titan
What kind of denials would we look up per the IDCS SOP in PMMIS for AZ?
Where in the Team OneNote can I locate what bucket I should be using in Omega?
Omega > Omega Baskets
3 business days
According to the PROS RP out of scope issues, which type of fee schedule is out of scope for PROs?
GPS Fee Schedules
Which RP would you use for new/updates to SOPs?
BRIDGE
How many days of PTO would require you to have to assign a PTO back up on cases?
6 or more
Which site can I locate all of UHC benefits and up to date information about the company?
Per the CS Spire Issue Research Scenarios in the OneSource, what kind of AZ claims can bill and will pay for lab codes if billed with other non-lab related codes?
Outpatient hospital claims billed on a UB
Where would we submit a ticket to verify a facility demographic request?
UHN
This macro RP is used to run reports through a ______ macro for testing to show reprocessing of claims.
DROID
What should we always do if we do not meet the providers expectations?
Provider education, SOT, etc
Looking for make a phone call.
Where will I be able to view my upcoming quarter check in with my manager?
MYGPS