Episource Product Training h5z6y

CALL DIALOGUE Hi. This is NAD. I’m calling from EPISOURCE on behalf of AETNA. I would like to request for medical records.

May I speak with someone who handles medical records?

Would you be able to help me with this?

This is for COMMERCIAL RISK ADJUSTMENT REVIEW, REVIEW, ICD-9 CODING and PROPER REIMBURSEMENT. REIMBURSEMENT. I’m calling to 1 out of 9 patients Patient’s Name: John Smith Date of Birth (DOB) 1/1/1983 Is he/she your patient? I have a request for 9 charts. Can I also your FAX #? What TYPE OF CHART does your office utilize?  Paper Charts  EMR (Electronic Medical Record)  What APPLICATION/SOFTWARE/SYSTEM are you using?  Hybrid (Paper + EMR) TURNAROUND TIME How long does your office normally fax the record back to us? If BEYOND 3-5 days turnaround time Unfortunately, we have a shorter deadline. I understand how busy your office is. Would it be possible for you to fax at an earlier time since I’m only requesting for 9 charts? Great! I’LL TAKE THAT! If office is requesting for MRT Unfortunately, we won’t be able to send a technician since this is only for less than 10 charts. Do you fax records directly from your office or do you utilize a COPY SERVICE? Recap 1 | Page N A D i fi c N o t e s B a n k Wave 2

I will be sending the FAX REQUEST over with a SIGNATURE LOG which the doctor needs to sign and my information will be there as well. If you have any questions, feel free to call us back and we’ll be happy to help. Thank you so much for your time. You have a wonderful day ahead!

Reasons for REIMBURSEMENT:  Copy Service  Office requesting payment directly from our office -

COPY SERVICE Offices

3rd party companies; providers pay a different company to submit/fax medical records for them Fax the request to copy service Patient Fax # Name Service

of

Copy HealthPort, Bactes, IOD, HealthMart (for AETNA only) Log A Call (PNP) – HealthPort or UCS 2 | Page N A D i fi c N o t e s B a n k Wave 2

Request INVOICE Send FAX Request

(Documentation of fee per release of chart) BILL sent to PERSONAL FAX #

PACKAGE

Log as SCHEDULED

NOT (until you have received invoice)

HEALTHPORT

-

Log A Call (PNP) – PNP Reason: UCS-HealthPort Name of Copy Service Type of copy service that does not negotiate Patient Fax # Send FAX Request

PACKAGE

PNP (Provider Participating)

Not

Office Requesting Payment directly from our office

Patient Fax # Request INVOICE Send FAX Request Log as SCHEDULED

(Documentation of fee per release of chart) BILL sent to PERSONAL FAX #

PACKAGE NOT (until you have received invoice)

Request for MRT SCHEDULE MRTs if we have one available in that area Address 3 | Page N A D i fi c N o t e s B a n k Wave 2

Dates of Availability

2 possible dates “When would be the next possible dates to accommodate a technician to come in to your office?”

Type of Chart Office Open-Close Hours Details

Lunch Hours

Salesforce Log Notes Open Activities Log A Call (Location SCHEDULED) If you were able to get a TURNAROUND Create NEW APPOINTMENT Salesforce DATE/SCHEDULE DATE  Appointment Type: FAX  Appointment Start Date/Time:  Estimated End Date/Time:

in

4 | Page N A D i fi c N o t e s B a n k Wave 2

Click SCHEDULE MRTs Location  Address  Dates of Availability 2 possible dates “When would be the next possible dates to accommodate a technician to come in to your office?”  Type of Chart  Office Open-Close Hours  Details (Lunch Hours) (

MRT

No other Conflicts

Log A Call (Location NOT SCHEDULED)

COPY SERVICE

Copy Services other than:  HealthPort  Bactes  IOD  HealthMart “What is the NAME of the copy service/copier?”

Office Requesting Payment directly from our office Round 1 of call; waiting for:  Invoice 5 | Page N A D i fi c N o t e s B a n k Wave 2

 Confirmation  Turnaround Date FedEx Label

 ADDRESS  Name of Person you’ve talked to Office requesting for FedEx Label , UPS Send approval request in Salesforce Assigned to: Jessa Mae Donga  Send Notification e-mail For Universal American Project only NOT Aetna

Log A Call (PNP) (until 5 attempts) Goal: <5% non-participation rate Include Notes:  # of attempts to reach office or schedule  Date when the calls were made/Dates of Attempts  Summary of PNP Reason  Office Info  Invoice FBD – First Appointment Beyond Due Date FMV – Failed Member Verification

With Provider but cannot Member “Does the doctor have ANOTHER office?” If none, search: 6 | Page N A D i fi c N o t e s B a n k Wave 2

NHP – Nursing Home Patient NRP – Non-Responsive Provider PSO – Prepaid Shipping Only REB – Reimbursement

UCS – HealthPort

UCS – Utilizes Copy Service

CNA – Chart Not Available

NPV – No Patient Visit

 Google  HealthGrades  WebMD  Vitals Ask where the nursing home facility is Always getting voicemail after many rounds within the day Office wants to receive or send the fax request via MAIL Office is charging for the fax package request State why are you calling: “This is for COMMERCIAL RISK ADJUSTMENT REVIEW, ICD-9 CODING and PROPER REIMBURSEMENT.” “I would request for an INVOICE and send it back to us if it will be approved or not.” AETNA (invoice not pre-approved) Universal American (invoice preapproved but not more than $30 Type of COPY SERVICE that does not want to negotiate and they are charging expensively “What is the NAME of the copy service/copier?” Copy Services other than HealthPort:  Bactes  IOD  HealthMart “What is the NAME of the copy service/copier?” Submit form to Document Management Team (NATHAN FOREMAN) and submits it to FILEBOUND

Submit form to Document Management Team (NATHAN FOREMAN) and submits it to FILEBOUND

7 | Page N A D i fi c N o t e s B a n k Wave 2

NSP – No Such Provider

Log A Call (FOLLOW UP) Round 2 of calls and up If office is requesting for a callback *ROUND*

2nd call attempt For all Round 2 calls scheduled date Not within the same day

without

Any call, voicemail or e-mail attempt at communication

8 | Page N A D i fi c N o t e s B a n k Wave 2

COMMENTS’ Format *Note any DISCREPANCY like wrong DOB*

JS 9/29/14 R1: Spoke with Stacy (Medical Records). I was able to 1/9 patients. Fax # is (800) 865-7942. Chart type is EMR-Practice Fusion (Application). Turnaround time is 7 days for fax. Fax package sent.

9 | Page N A D i fi c N o t e s B a n k Wave 2

Click LOCATIONS tab Phone 1 Phone 2 Health Plan ID

Requires Chart or Fax List Chart List Faxed

Type Fax: (800) 865-7942 Paper Charts EMR (Application) Hybrid (Application) If NO Turnaround Date/Schedule Date  If you have a TURNAROUND DATE/SCHEDULE DATE    

10 | P a g e N A D i fi c N o t e s B a n k Wave 2

FHSMP

FAX PACKAGE

Fax Cover Sheet FS Coversheet Worksheet (Excel)

Health Plan Letter Signature Log Member List Copy Project Name to Chart ID (Excel)

Patient Cover Sheet

Fax Appointment Confirmation Office: Dr. John Smith Attn: Medical Records – Stacy Fax #: (800) 865-7942 From: Jonard Siapno Phone: 855.874.1852 Fax #: (800) 865-7942 Email: [email protected] Your Schedule Due Date: 10/10/2014 Request for Medical Records 2 pages for Aetna Sent to OC’s personal fax # (efax) Salesforce → Generate Chart List → Export Details → Export Project Name Provider Member’s Name Date of Birth (DOB) Chart ID 1 cover page for each patient

PDF Filename: Office/Doctor Name – Project Name Dr. John Smith - AETNA Save in EpiShare Salesforce Notes & Attachment Attach File

11 | P a g e N A D i fi c N o t e s B a n k Wave 2

TOOLS

SEARCH ENGINES

RETRIEVAL METHODS (the way how charts are sent to us)) Field Appointment (MRT)

Technician will go to the Provider’s office Always ADDRESS 12 | P a g e N A D i fi c N o t e s B a n k Wave 2

Corporate Team: Schedule via Salesforce Abroad: Submit requests to Stacy Mejorado (Corporate Trainer) Remote EMR

name

Secure Data Transfer Secure Email

Email: [email protected]

Secure Mail

Office requesting for FedEx Label , UPS Send approval request in Salesforce Assigned to: Jessa Mae Donga For Universal American Project only NOT Aetna #1 Option for LESS THAN 10 CHARTS request Fax #: (800) 865-7942

FAX

CHART PARTS Progress Notes

Vitals

Consult Notes

Specialists

Medication & Problem List & Past Medical History History & Physical

Form of notes

Labs

Pathology Report

Hospital Records

it, discharge

Diagnostics

Imaging Diagnostics – Radiology

*** DO NOT SCAN docs outside the DATES OF SERVICE *** Aetna DOS: January 1, 2013 to Present (December 31, 2014)

Building a healthier world 13 | P a g e N A D i fi c N o t e s B a n k Wave 2

Aetna is transforming health care to create healthier communities, a healthier nation and a healthier world. Let us show you how we’re focused on helping to create a healthier you. Our corporate profile Founded in 1853 in Hartford, CT, Aetna is committed to providing individuals, employers, health care professionals, producers and others with innovative benefits, products and services. Discover more about our organization.

List of ICD-9 Codes The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems.   

List of ICD-9 codes 001–139: infectious and parasitic diseases List of ICD-9 codes 140–239: neoplasms List of ICD-9 codes 240–279: endocrine, nutritional and metabolic diseases, and immunity disorders



List of ICD-9 codes 280–289: diseases of the blood and blood-forming organs



List of ICD-9 codes 290–319: mental disorders



List of ICD-9 codes 320–359: diseases of the nervous system



List of ICD-9 codes 360–389: diseases of the sense organs



List of ICD-9 codes 390–459: diseases of the circulatory system



List of ICD-9 codes 460–519: diseases of the respiratory system



List of ICD-9 codes 520–579: diseases of the digestive system



List of ICD-9 codes 580–629: diseases of the genitourinary system

  

List of ICD-9 codes 630–679: complications of pregnancy, childbirth, and the puerperium List of ICD-9 codes 680–709: diseases of the skin and subcutaneous tissue List of ICD-9 codes 710–739: diseases of the musculoskeletal system and connective tissue

14 | P a g e N A D i fi c N o t e s B a n k Wave 2



List of ICD-9 codes 740–759: congenital anomalies



List of ICD-9 codes 760–779: certain conditions originating in the perinatal period



List of ICD-9 codes 780–799: symptoms, signs, and ill-defined conditions



List of ICD-9 codes 800–999: injury and poisoning



List of ICD-9 codes E and V codes: external causes of injury and supplemental classification

15 | P a g e N A D i fi c N o t e s B a n k Wave 2