Process
After stating your initial "Hi my name is _____ I'm calling from Humana on a recorded line" when working on HEDIS what's the next thing is you must state for your initial
"We're collecting Hedis data as required by the CMS and NCQA"
What does LSC stands for?
Lead Screening in Children
When documenting a successful contact for initial on HEDIS is the following correct the right way to start the note? Initial MRA 2024 (3) - Called 111-222-3333.....
No, it will be Initial HEDIS 2025 (3) - Called 111-222-3333.....
Remember we are working HEDIS project it is always important to put the name of the project on your notes
Are you required to read back the DOS and Gap measure to the provider to make them aware during your call?
No, however if they ask for it you can refer back to the current list of gap measures, we are working during this season and so we can make them aware about any details for the gap measure we are requesting for the patient.
Do we collect COL (Colonoscopy) during this current HEDIS season?
No, we don't
On HEDIS calls if provider is unable to verify patients, we left a message, we reached an answering service or we reached a busy signal do we still have to verify patients on claims?
Yes, we always must attempt to verify patients on claims, if you don't reach a person at the office or they don't want to verify patients we must always perform research for at least 3 patients
What is the turnaround for HEDIS?
3 Business days
Is a provider signature required for COA: Care for older adults?
Yes, it is required
What is the call back number when leaving a message for HEDIS?
866-444-8094
Do we ask for a provider signature while on the phone with the provider?
No, however there are gap measures that may require signature
What is the Date of Services required for CCS: Cervical Cancer Screening?
Jan 1 2020 - Dec 31, 2024
If the provider request for invoice and they allow you to send our own invoice what is going to be the action and next action for your first note?
Action: Invoice Requested - Next action: Call
Will we use the same actions and next actions when a provider gives a hard or soft commit or even on an invoice scenario that we use for MRA on HEDIS? True or False
True we will use the same actions and next actions
What is the action and next action if we encounter inappropiate provider situation?
Action: Call - Next Action: Research
On Inbound what action and next action should we use when receiving a call for an RRS site?
Action: PT inbound call RRS - Next Action: PT inbound call RRS