1st Attempts
What journal template do we use when we are sending a successful attempt after speaking with the attendant?
Scenario 1
What does ADC Stand for and what is our new ADC
Average days to Complete, 10 business days
What are the only response sources we use the intake queue?
Verbal and Other
What journal template do we use when we find that none of the reject categories are correct, but we find a reason to reject the request
Scenario 4: Reviewed the rejection reasons generated by IBM’s automation and found that they were inaccurate. During review, a different rejection reason was identified. Rejecting the PMR request.
How many task areas are in PMR?
What are the ways we can send the request?
Fax and US Mail
Where is the provider information listed on the request?
4142A
What do we do with requests that have to be closed as Invalid with no call.
Use the dummy link to close the request on day one.
http://www.ibm.com/no-call-PHP-information-provided-invalid
What journal is used for Exact Duplicates?
Found in the SOPs : IBM has a duplicate check in place upstream to handle this.
What task does the system always default too?
Reject Review Queue
If we have a doctors only request, can we send the request if the record states a facility and we are able to confirm the doctor on the PHPs website?
Yes
In what scenario would we mail a request to the provider?
Per Provider’s request.
If the provider/facility is confirmed, and there is no fax #.
After preforming research and unable to locate contact information and the address is not invalid (day one)
How do you ROC a request in IBM's Platform?
Update “Last Contacted” date.
Add call recording
Add Comment
Select ‘Upload Response Document’
Change Request Status to ‘PMR Refusal’
Change ‘Type of Refusal Provided’ to ‘Verbal’
Select Refusal Reason based on provider response
Select ‘PROVIDER VERIFIED’
How do we reject a request in Intake.
Switch the "IS -- a NON Private Provider" to Yes, add the appropriate comment, then hit reject
Where do we add the POC in the custom fields?
There is no POC Custom fields
What button is pressed when we were unable to confirm the facility/doctor listed but have a valid address?
Provider Verification Failed
What are the minimum requirements for PHP information listed on the 4142a in order for us to be able to process the request? (List all please)
Facility/provider name along with City and State, 2. Facility/Provider Name along with phone number. 3. Facility/provider name along with a zip code
We are requesting records from Virginia Hospital Center. At the time of the call, we are informed that the patient was transferred to Bon Secours St Francis Medical Center, and they do not have access to any of the records anymore. What Non-PMR Response Category would this request be closed with?
No Records Found
Can Intake reject a clear Non Private Provider?
Yes - Scenario 10 Journal 3
Where do we add urgent onto the cover page.
There is no longer a custom field for cover page notes.
If the recording confirms the facility but we do not have a fax # to send the request, Do we mail it or make it a PHP Not Reached?
Mail the request - Provider Verified
What are the main Objectives of First Attempts
Reach the correct PHP: ensure you have contacted the correct facility and/or doctor, Ask for the medical records department.
Establish why you are calling: To obtain an email address or fax # to send a medical records request.
Confirm that the provider has records for the patient (the veteran or claimant)
Confirm/Update/Obtain PHP information with the Point of Contact: Address, email, fax, direct phone number to medical records department.
Overcome any objections that may be presented.
Have a POC Commit to a turnaround time.
Set an expectation: You will be providing a cover page that will have instructions on how the provider can return records
If the phone number listed on the request is invalid/disconnected/out of service/beeps etc., and we are unable to locate an alternate phone # and there is not a complete address listed on the request, the request will be closed as what NON- PMR Response category?
PHP Information invalid
When do we OffRamp a request?
Reject Category - Unable to Locate Vet in VBMS
Can we update the providers address?
We can make small updates to the address like the zip code and adding a suite. DO NOT COMPLETELY CHANGE THE ADDRESS UNLESS IT WAS VERBALLY PROVIDED TO YOU. (recording does not count)