Projects
What does MRA stands for?
Medicare Risk Adjustment
If the providers have any questions or concerns on why we are requesting medical records will they be able to find the answers under the packet? Yes or No
Can we eat and munch during a call? True or False
False, don't do that
What is the turnaround for MRA project?
5-7 Business days
Where can you locate the DNC list?
Under Go/Raks
What does HEDIS stands for?
Healthcare Effectiveness Data Information Set
The provider is able to locate the password for the Humana upload portal under the packet? True or False
True and the password will always be "secure62"
What are soft skills?
Soft skills are personal attributes needed for on-the-job success. Soft skills are also known as interpersonal (people) skills
True or False: If a provider doesn't commit within a 5-7 business days but instead commits to a 30 days turnaround it will be considered a commit?
How many patients we must verify on each call?
3 patients
Main difference between MRA and HEDIS?
HEDIS asks for Labs and it doesn't require provider signature.
What is included on the packet?
• The fax Cover sheet • The provider Letter • The Member Pull List • Directions for Returning Records • Invoice Document (optional)
What are hard skills?
Hard skills are job-specific skills and the knowledge needed to perform a certain job (e.g. certifications & licenses)
If the site you're working is on the DNC list what is the action next action?
Action: Call
Next Action: Research
Besides patients what other information needs to be verified on an initial call?
Site name, Address, Fax, obtain name of person you spoke with, DOS, how they store their records and the EMR system if this applies
How many projects are worked within Humana?
6 (7 if we count H944)
Where will the provider be able to locate site id under the request packet?
Bottom left on every page
Why is it important to smile during a call?
It is easier to sound friendly and positive towards the caller
Your first call on a site that has not been contact for the season will always be a what?
Initial call
What is a provider commit?
is a call where you request medical records, and the provider agrees to send them.
Does MRA always require the provider signature? True or false?
True
Where will you able to locate the tracking number under the packet?
Last page
What is the golden rule?
"Treat others how you would like to be treated"
What is the action/next action if a provider commits?
Next Action: Prov Rec Committed
If the RP value is more than 6 are we allowed to work the request? Yes, or no?
No, we only work requests with RP of 1-6