Show:
Cleaning
Initial Record Requests
Follow Up Record Requests
CLSIs
Project 101
100
This is the process of taking new data from the health plan and updating the formatting and confirming the contact information to prepare for the IRR phase.
What is cleaning?
100
When sending out a medical record request, this is the single most important piece of information that needs to be confirmed.
What is the fax number?
100
This page is used to find information about our history with the site. It is important during FURRs because we can see information about when the IRR was sent, and who we spoke with when we sent it.
What is the contact log?
100
This CLSI would be used when we successfully send out a medical record request for the first time.
What is "IRR"?
100
A risk adjustment project that we do for the majority of the year. It is not mandatory for most health plans.
What is CARA?
200
This is what we label a site that has incorrect information and we cannot find correct information for it.
What is bad data?
200
If we come across an issue that we cannot resolve, we would need to ________ the site.
What is "escalate"?
200
During a follow up call, we should have this page open before contact the site. We do this because then we have the patient names readily available to provide to the site.
What is the "Manage Requests" page?
200
This CLSI would be used during cleaning.
What is "CLN"?
200
A mandatory project that we complete once per year.
What is HEDIS?
300
We use these two internet search engines to find alternate information for sites.
What are Google and Bing?
300
These two places should be checked for information prior to contacting any site. One place shows our history with the site, the other place shows any important information we may need to know prior to contacting the site.
What are the Key Comments & Contact Log?
300
Anytime we we need to resend the record request to the site, we need to be sure we are confirming these two key pieces of information.
What are the fax number and the address?
300
This CLSI would be used if we are calling a site to follow up on a medical record request for the 3rd time.
What is "3FURR"?
300
CARA reviews are different from HEDIS reviews because they look at dates of services instead of ___________.
What is "measures"?
400
Before searching for a possible merge in the cleaning clean, we need to choose this option from the "Status" drop down menu.
What is "All Other Statuses"?
400
If a site has more than 5 members being requested, is should be flipped to this status.
What is scheduling?
400
This is the productivity standard for FURRs.
What is 50 sites per day?
400
This CLSI would be used if we are making a 2nd attempt at sending over a medical record request, but have not been successful.
What is "2ARR"?
400
Health Plans submit the findings of our CARA projects to this Federal organization for reimbursement purposes.
What is CMS?
500
This is the bad data reason code we would use when we are provided with a disconnected phone number and we are unable to find any alternate information after doing internet searches.
What is "Phone Disconnected- Unable to get alternate number"?
500
65 sites per day
What is the productivity standard for IRRs?
500
When a site asks for a signed patient authorization prior to sending records, we should explain to them that we are covered under HIPAA as a _____________ of the health plan.
What is a business associate?
500
This CLSI would be used when a site calls us, or when we are adding information to the contact log without altering the request.
What is "RRLU"?
500
The acronym for this is "HEDIS."
What is Healthcare Effectiveness Data & Information Set?