Show:
Pre-Verification
Detection
GMR
Mobility Assessments
Misc
100

The pre-verification process comes ___ the detection process. 

after 

100
How often do you download a new member list from Quicksight? 

Daily 

100

The GMR specialist reviews claims in the ___ status. 

Submitted 

100

In which scenario can you automatically downgrade a member without calling the member? 

When a member has taken 2 trips in a downgraded modality. 

100

What do you do when a facility doesn't pick up the phone on the first try? 

You call again at a different time. 

200

Pre-verification specialist verifies the ride __ hours in advance 

24 

200

How are the members ordered on the Quicksight list? 

Highest distance to lowest distance members.  

Highest cost to lowest cost members.

200

GMR specialist reviews rides that equal and/or greater than ___miles. 

30 

200

In which scenario will a member be upgraded to AMB even if they don't need assistance and can take a rideshare? 

When a member doesn't have a cellphone. 

200

What do you when the facility doesn't pick up the phone for the second time? 

Call the member

300
What are two things you can check for without researching the address in Google? 
1) Non-residential address. 

2) Member going to a facility no covered by the health-plan. 

300

What do you do when a facility doesn't pick up on the second attempt? 

You can check Observe AI

300

What does the GMR specialist do to verify a ride to a non-medical facility (for example - a Grocery Store, Gym)? 

Check the ride to the address. 

300
Which 3 scenarios would you upgrade someone from WCV to WCX? 
Combined weight > 600 lbs. 

Width > 34 lbs. 

If they aren't able to transfer even with assistance. 


300

How often does the detection specialist update their notes? 

Every 3 months 

400

What do you do when a member doesn't pick up the phone for the first time? 

Call the member again

400
What are the treatment types that have the highest instances of fraud? 

Pharmacy/Unknown Steven 

400

How does the GMR specialist document rides where the member and the facility were unreachable? 

UTR 

400

What is the format of the mobility downgrade note? 

DD/MM/YYYY - FWA Confirmed - Your Initials - Mobility Assessment - CSR please only book rides as ‘Downgraded modality’.

400

How do you verify rides that are non-medical? 

Confirm the ride to the address is consistent with the treatment type. 
500

What type of trips you can't cancel even if you called the facility and they said they don't have an appointment? 

Life-sustaining trip 

500

What do you do when the treatment type doesn't match the Google research? 

Call the facility

500

What department would you ask for if you call a big facility with many different treatment types? 

Ask for Billing 

500
Who do you call when a member has taken a life-sustaining trip in the past? 

Facility first

500

What is the format for a note that confirms FWA? 

MM/DD/YYYY - FWA Confirmed - SH (i.e Your Initials)  - Treatment Type – Residential address