Referral Ownership
Do you remember
Insurance
100

If NMS owns the referral, you should add this WQ note before deferring

What is "NMS - Out of Scope"?

100

What dates are you documenting your time punches

What is Sept - 14, 15 and 16th 

100

 

What does NPR stand for?

No Precert Required

200

When another team is already working the referral, you should do this.

 What is defer, assign and document the owner?

200

 This process applies to lab referrals placed more than this many calendar days after the date of service.

What is 5 calendar days?

200

One of the Golden Rules asks when reviewing a referral to determine whether this requires action.

What is the insurance?

300

Mills referrals should be deferred using this option.

What is Defer Using Other?

300

A referral with this status may remain in the WQ. 

What is Open Status?

What is Closed Status?

300

 A patient has Blue Cross insurance from another state. Before processing the referral, you should review the insurance card and contact this resource if needed.

What is BlueCard?

400

Name at least 2 of the NMS Surgery Schedulers names who you might see assigned to an NMS referral 

Susana Peralta, Jacqueline Tran, Abby Robles, Rachelle Garcia, Cheryl Soltero, Keira Mason, and Michelle Montoya.

 

400

 If you're looking for insurance workflows, referral ownership guides, smart phrases, or training materials, this is where you should start.

What is the Centralized Authorization Site?

400

 Verification is required before NPR when this insurance combination exists. 

What is PPO Primary + HMO Secondary?

500

What are the specialty departments and locations owned and processed by NMS?

  • SGSV Sports Medicine Palo Alto
  • SGSV Podiatry Palo Alto
  • SGSV Podiatry Los Altos
  • SGSV Podiatry Burlingame
  • SGSV Podiatry San Carlos
  • SGSV Podiatry Daly City
  • SGSV Physical Medicine & Rehab Palo Alto
  • SGSV Physical Medicine & Rehab Burlingame
  • SGSV Physical Medicine & Rehab San Carlos
  • SGSV Neuro Surgery Palo Alto
  • SGSV Ortho Surgery Palo Alto
  • SGSV Ortho Surgery Burlingame
  • SGSV Ortho Surgery San Carlos
  • SGSV Ortho Surgery Daly City
500

The three major steps in the Retro Lab Referral process.

What are Use the SmartPhrase, Close the Referral, and Close the Loop?

500

Four steps should occur for this insurance type including closing referral and notifying the provider office

What is Non-Contracted Insurance?