Another word for a person who undergoes medical treatment or if that person has fortitude and calmness
What is patient?
100
This department receives PEGA referrals for RTP, suspended claims over 30 days but they don't want it if it's on the claims issues log
What is Claims (Part A and/or Part B) or Claims/Suspense?
100
Examples include performance appraisal, appointments with HR, employee testing.
What is meeting?
100
855A, 855I, 855R, 855O
What types of enrollment applications?
100
PCC
What is Provider Contact Center?
200
The name of Cahaba's Customer
What is CMS?
200
This department processes invoices, Medical records and ADS responses.
What is Medical Review?
200
Examples include Compliance presentations, Friday on-going refresher training, Quarterly Assessments
What is training?
200
pending prescreen, resolved, rejected
What is the status of application?
200
POE
What Provider Outreach and Education?
300
This portion of the QCM scorecard includes interactions with the caller and has six sub-skills
What is Customer Skills?
300
Another term for a PEGA referral to your SSC.
What is Level II?
300
Logging out to go home at the end of the day or for emergency evaculation.
What is end duty?
300
Alicia Brady -Wright
Who is the PCC provider enrollment analyst?
300
LCD
What is local coverage determination?
400
This portion of the QCM scorecard divides the call into six specific Performance Criteria that address how well the CSR interacts with the caller. It allows assessment of how well the CSR demonstrated the skills listed.
What is Customer Skills?
400
Another term for a PEGA referral to the PRRS Suzanne Evans.
What is Level III ?
400
Examples include restroom breaks, texting, calls from relatitives, paying bills, checking voicemail, working emails from HR.
What is personal?
400
Application is 90 days or older, third call from provider, second call is within at least 7 business days of initial call
What is task force criteria?
400
PRRS
What is Provider Relations Research Specialist?
500
Name one type of business partner or caller?
What are...?
1. Provider
2. Biller
3. Facility Administrtor
500
One of the departments that can't receive referrals through PEGA.
What are...?
1. Appeals
2. POE
3. PAAR, Part A Financial Overpayments, or Reimbursements
4. Compliance
5. Process Control
6. Support Services
7. EDI
8. MR
9. Accounting
500
Logging out for problems with the computer, furniture, phone or headset but doesn't include a forgotten badge.
What is Equipment?
500
Wendy, Corene, Sherrie
Who are the task force team?
500
HIPAA
What is Health Insurance Portability and Accountability Act?