Unsuccessful Contacts
In theory what is an unsuccessful contact?
True or false when working signatures, we must verify provider information
True
If you are unable to get a hold of a provider and you're unable to locate any good numbers, what are your action and next action?
Action: Call
Next Action: Research
What is a provider refusal?
When a provider doesn't want to cooperate or doesn't agree to return the records back to us
What 5 sources do we have available to lookup for a different contact number for a provider?
Healthgrades, NPI, Physician Finder and /or Whitepages & claims
What do we request for when working on Signature project?
Provider signatures
What is the action and next action when you get a busy signal?
Action: Busy Signal/no answer 1/2/3
Next action: Call
Who do we email when a provider refuses to return records back to us?
We email Lo's and CC TL
How many attempts do we have to try to contact a provider where we are only getting busy signals?
3
When working signatures if a provider has moved to a different facility are we allowed to update site information to match the new information we have?
No, we are creating a signature attestation
We email Rhema Bumphus at RBumphus@humana.com
Why do we use CRM?
To locate patient claim number
Are we allowed to verify information with answering services?
No, we can just finish the call
Can we use any request ID we find on our note tab row to search for the signature on cotiviti?
We need to use Parent Request ID
Who do we email if a provider states that the patient's name is not correct and doesn't match on their system?
RA Vendor Systems Support
How many times can we follow up?
We do 2 follow ups, after that we must ask for instructions from our Lo's
For how long we can wait on call if a provider put us on hold?
5 minutes
There will be some instances where we do have a signature on file for the medical records but what could be some reasons we are still asking for the signature?
Missing Credentials • Provider signature is Present but Illegible and or not identifiable • A signature stamp could have been used which is unacceptable • A signature may be missing for the date of service we are retrieving. • Or a signature maybe pending; this is where there is an electronic signature, but the signature states pending
Do new agents email the market for Remote Access Requests?
No, only experienced agents
After obtaining a claim number on speedweb what is the next step?
Use the claim number on ehub