Intake Essentials
The time in which a lead is to be followed up on
What is 24-48 hours
Typically 5-15 days
What is the time it typically takes a funding source to provide information back on a request for funding services
COB stands for
Coordination of Benefits
To maximize revenue by effectively managing claims, payments and billing
What is the primary goal of Revenue Cycle Management
Sharepoint
What is the Learn Portal where you can find detailed information on intake and Authorizations process and protocols
Telephone and email
What are acceptable ways to communicate with the client/family
Email sent to scheduling and clinicals team at the end of the work day
What is the Funding Entered Email
Bi- monthly checks, or frequency in which the insurance requires
What is our eligibility checks via Waystar and other funding source portals
Review the denial reason, add the missing information and resubmit the claim
What are the steps taken if a claim is denied due to missing information
Contacting the family to get updated insurance details and verify coverage with the new plan
What is the steps to take when a family changes their funding
Co-insurance, co-pays, MOOP
What is the benefits to a client's insurance and is sent via email to family to confirm before services are started
Out of pocket agreement for services
Family adds another policy
What is the reason an insurance may request a COB
Top Drivers of denials
What is credentialing, claim/ lacks service information, Authorization Denials, service not covered, eligibility, COB, Claim/service lacks info for adjudication, Medical Record Request
Ensures our clients are eligible every month - 2x a month
What is Routine bi-monthly checks through Waystar
CSA, CFRA, Diagnostic Report, RX
What is documents that are in the Intake Packet collected by an Intake Coordinator prior to starting services
Submit an addendum report with update information or complete a peer review
What is when the initial request is not fully approved. These are next steps depending on funding source to get a further review
Private Pay, Medicaid, grants, private insurance
What are all the types of funding Learn accepts for services
Central Reach filters, 'no invoice', 'no claim', 'authorized'
What are appropriate filters to identify unbilled claims
DOMO
What is a cloud based platform that connects data real time from CR. Creates cards on data regarding authorization entries, report due dates, client integrity, credentialing, RCM issues, $ at risk month:month
These are the # of states in which LEARN offers services of DE, ABA, SPOT
What is Oregon, California, Nevada, Arizona, New Mexico, Wisconsin, Indiana, Michigan, Illinois, Arkansas, Louisiana, Massachusetts, New Hampshire, Vermont, Maryland, Virginia, North Carolina, Washington (until 12/31)- 18 states
All services require prior authorization
Lis and Team
What are the team who connects with our clinical, billing, authorizations and family about outstanding payments and provides resources specific to locals to ensure services are paid in full
Compare the payment to the contracted rate, submit an appeal or inquiry to the insurance with documentation, and request an adjustment or additional payment.
What are the steps to follow if an insurance claim was underpaid according to the agreed contract rate
Unknown coverage under Insurance and service have/are being provided
What is a need for teams UM, RCM to collaborate with clinical on a plan to advise family of potential risk of financial responsibility, plan to resolve that outstanding balance and conversation on risk of continuation of services