Recruiting Statuses
A lead has been research by a campaign associate, what status would this lead be placed into? How long can it be in this status for?
Contact Confirmed. Minimum of 2 weeks.
A provider says they are not interested in joining because they only accept cash patients. What status reason do you use to close this lead?
Does not participate in health plan programs - Cash only.
A physical therapy group calls into join for Cigna only but has a medical doctor billing under their TIN. What status reason would be used to close this lead?
Not in Scope
You call a lead on behalf of the PCO and the provider says they're already in network with that health plan. After checking Promis and finding they are participating with ASH, you update the activities with their ASH ID and then put the lead in what status reason?
Active
A Nutrition Services provider in California calls into the queue requesting an application. While gathering information you find out that they do not have a CDR card. What status and status reason do you use for this lead? Why?
Ineligible - Licensure.
In CA, NS providers are required to have a CDR card. Since this provider does not that makes them ineligible to join due to not meeting licensure requirements.
A queue call comes in for a recruiter who is currently on lunch. You take down the information on their behalf and email them the link to the CRM lead. What status should the lead be place in?
Requested Materials
You've called your Nom lead 7 times to their personal cell phone number with no response to any of your voicemails. On the 7th attempt you leave voicemail using the final voicemail messaging. What status reason do you use to close this lead?
No response to message.
You call a massage therapist and find that they only treat patients at Massage Envy. What status reason do you use for this lead?
Under Contract
You call a provider whose lead shows they're in Georgia but they tell you they've moved to New York. What do you do with the Georgia lead?
Note the information in the activities and close the lead as Closed/Moved.
You call a lead in the Aetna AL Chiro and MD 2023 | Acu campaign. The chiropractor does not provide acupuncture services. What status and status reason do you use for the Acupuncture lead? Why?
End Recruiting - Not Practicing.
The provider is eligible to provide acupuncture services under their DC scope of practice but does not provide those services. This would not be closed as ineligible due to licensure because the chiropractor would not need to be licensed for acupuncture.
You call a non-rehab provider and their voicemail greeting states the clinic name, but not the provider's name. During your research you found this provider was practicing at this clinic. What status reason do you use? Why?
Attempt left message / voicemail (verified).
Although the greeting does not say the provider's name specifically, it's been researched this provider practices at this clinic so that is considered verified.
You've spoken to this provider and sent over some information. After sending the information they've become non-responsive. After leaving a few unanswered voicemails you leave a final voicemail. What status reason do you choose when closing this lead?
No Reason / No Comments
A provider calls into the queue requesting an application. You see they submitted an application earlier this year and check Promis. There you see they were denied 3 months ago by credentialing. What status reason should the lead be placed in?
You call a DC provider on behalf of the PCO and speak with the provider. They explain that they are already participating with us so you check promis and do an advanced find as this lead has zero previous activities indicating any recruitment. You find they are par, and there is another lead that was created 4 years ago for this provider. What status reason do you use for your lead? Why?
Duplicate practitioner / provider.
The lead is a duplicate of the older one so this should be closed as a dupe and emailed to CN support to disqualify and move campaigns.
The original lead would be closed as Active if it was not already in that status reason.
You call a provider in the Cigna PNW campaign. They express they are not interested in joining due to rates, however, we are openly negotiating for this campaign. The provider is not interested in negotiating despite your efforts. What status and status reason would you use to close this lead? Why?
Not Interested - No Reason / No Comments.
This provider says they aren't interested due to rates but do not want to negotiate. This tells us there's another reason why they aren't interested that they won't tell us.
A lead was previously closed due to a not interested status within the last 3 months. We recently started administering a new benefit so this lead was loaded into that campaign. What status reason would this lead be placed into by CN Support? How many calls must be placed before the lead can be closed again?
Reengage provider.
Only one call needs to be placed to inform the provider of this new benefit and then the lead can be closed for the previous reason if a voicemail is left or they are still not interested after speaking with them.
A provider explains they do not want to join the network because they do not want to deal with MNR and they find our rates too low for the extra would MNR would require. What status reason would be used in this scenario? Why?
Too much paperwork.
We would use too much paperwork over low fee schedule because there's a possibility we can negotiate rates, but we cannot negotiate MNR.
A provider explains they only treat for about 4 hours a week and are by appointment only. What status reason do you use?
Part Time
You conduct research on a provider on the PCO but are not able to find any information on Google, NPI, CAQH, or a licensing board. You see there is a phone number in the lead but it's to a generic voicemail greeting. You call and leave 3 voicemails but get no response. What do you put as the status reason? Why?
No valid contact info.
The phone number was to a generic vm greeting so it's unverified. Also there was no additional contact info found through research. We would not choose no response to message because we cannot verify we were actually calling the provider.
A field recruiter stopped by your providers office and dropped off the information packet as the office was closed. You call them the next day to follow up on the field visit and to confirm the information was received. The office manager explains they received the packet and will be reviewing it later this week with the owner. What would the status and status reason after this call? Why?
Recruiting - Reviewing.
This status would be used because they have confirmed receipt of information but have not made a decision yet as they are still reviewing the information.
You submit an application but receive a kickback for missing malpractice. Do you update the status reason and if so, to what?
Yes, Contract received incomplete
You call a provider on behalf of a Aetna match campaign. The provider explains that they do not work with TPA's and only participate directly with health plans. What status reason do you use to close the lead and why?
Does not participate with 3rd party payors - health plan direct only.
The provider does participate with insurance but they do not like working with TPAs.
A massage therapist calls in to request an application. While gathering information you inquire about their practicing address. They explain they are strictly mobile and do not see any patients at a clinic or in their own home. What do you put as the status reason? (200 points) Why? (300 points)
Facility requirement (mobile & fitness).
We cannot credential TM providers who are strictly mobile. They would need to have a physical location patients could be treated at as well, for us to be able to credential them.
A chiropractor says they only provide chiropractic adjustments to animals. What status reason do you use for this lead? Why?
Not Practicing.
The reason we choose 'Not Practicing' is because their license/state allows them to practice on people but they choose not to at this time. Kind of like the providers who choose not to practice MT under their DC scope of licensure (if permitted in their state). It is temporary they can change their mind and start practicing on people at anytime, therefore it does not make as much sense to say 'ineligible' or 'not in scope.'
You're speaking with a provider and they express that they are not interested in joining the Network due to past experiences with us. They explain that they had issues with claims being paid and they could not afford to hire someone to deal with the paperwork and follow up on claims. What status and status reason would be used in this scenario? Why?
Not interested - No reason / no comments.
The primary reason they are not interested is due to experiencing claim denials in the past. We do not have a designated status reason for claim denials, so this status and status reason would be used.