Tabs
Run a patient's insurance to find out their estimated visit cost.
What is Cost Estimator?
Care Advocates can assist with "the basics" when it comes to Patient Billing. We can assist with:
•Update card and billing information
•Accepting payments
•Adding insurance coverage retroactively
•See the status of a claim
•Resending the patient’s bill if they lost it/did not receive it
Handles tasks such as ordering or filling out forms related to specialty tests like Cologuard, Genesight, etc.
What is Specialty Testing?
Our Nurses can authorize a different quantity of pills to be dispensed if it's equal to the physician’s ordered dosage.
What is Quantity Change?
Handles outbound calls to pharmacies, labs, and other medical facilities to assist with certain prescription-related tasks, request lab and test results, and resolve other miscellaneous issues with outside facilities that affect patient care at vPC .
Who is the outbound call team?
Search for and book available appointments, cancel or reschedule existing appointments, and send itemized appointment receipts.
What is Appointments?
Anything outside of this list should be sent to the Billing Team to handle. What are some examples?
•Cancel/invalidate claims
•See payments made through third-party vendors
•See who the claim was submitted under
•Apero payment link issues
Completes work-related forms such as FMLA, LOA, Disability, etc. when requested by the patien and approved by the physician.
What is FMLA?
Our Nurses can authorize the substitution of generic drugs to brand-named drugs and vice versa.
What is Generic to Brand Name?
Performs tasks and resolves issues related to our therapy program such as adding patients to their state's waiting list, rescheduling appointments missed by the therapist, and investigating patient requests to change therapists.
Who is the Therapy Team?
View clinical notes, diagnosis codes, and prescriptions ordered during completed appointments.
What is Encounters?
Anytime we send a ticket to Billing you'll need to assign it to Billing as_________
What is OPEN?
Submits prior authorizations to insurance companies and communicates the decision and next steps to the patient once a determination has been made by the insurance.
What is Prior Authorizations?
Our Nurses can authorize the substitution of capsules to tablets and vice versa.
What is Capsules to Tablets?
Handles most patient questions or issues when their treating physician is unavailable to do so themselves within the allotted response time of the request
Who is the cross coverage team?
View a patient's membership status, and cancel and refund memberships.
What is Subscription Members?
Patients who will not be able to attend their appointment must cancel or reschedule the appointment, or contact PlushCare support to cancel or reschedule the appointment. If the patient does not show up for their appointment, it is considered a no-show and the patient will be charged
What is a $75 no-show fee?
Compiles patient medical records to be sent to patients, other medical facilities, insurance companies, legal offices, etc. when requested.
What is Medical Records?
Given the Wegovy shortage, some insurances are permitting_______ substitutions. Nurse can assist with calling this in to the patient's pharmacy.
What is Ozempic?
Monitors patient questions sent to their doctors to ensure they are being addressed within the appropriate timeframe, forwards doctor responses back to the patient, and uploads outside lab results (i.e., not ordered by vPC) and all referral results to the respective patient's chart.
Who is the Doctors Questions Team?
Verify provider information including NPI, state licenses and expiration dates, and PCP eligibility.
What is Doctors?
______ can take 5-10 business days to reflect on your account depending on your bank.
What are refunds?
Provides patient medical information to county health departments when requested, usually due to positive STD tests
What is Morbidity Reports?
Our Nurses can authorize a quantity change if the box only comes in 100.
What are pen needles?
Assists with a variety of medical requests and issues such as calling in standing orders, discussing side effects to medications, and providing next steps when patients aren't feeling better after starting recommended treatments,
Who is the Nurse Team?