CALL DIALOGUE

Hi. This is NAD.

Im 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.
Im calling to verify 1 out of 9 patients
Patients 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 verify 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)
Verify 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 Im only requesting for 9
charts?
Great! ILL TAKE THAT!
If office is requesting for MRT
Unfortunately, we wont 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
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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 well 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
Verify Patient
Verify Fax #
Name
Service

of

Copy HealthPort, Bactes, IOD, HealthMart

(for AETNA only)
Log A Call (PNP) HealthPort or
UCS
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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

Verify Name of Copy Service
Type of copy service that does not negotiate
Verify Patient
Verify Fax #
Send
FAX
Request

PACKAGE

PNP
(Provider
Participating)

Not

Office Requesting Payment directly from our office

Verify Patient
Verify 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
Verify Address
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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

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Click SCHEDULE MRTs

Location
Verify 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
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 Confirmation
Turnaround Date
FedEx Label

VERIFY ADDRESS
Name of Person youve 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 Contact Info
Invoice
FBD First Appointment Beyond
Due Date
FMV Failed Member Verification

With Provider but cannot verify Member

Does the doctor have ANOTHER
office?
If none, search:
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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

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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

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COMMENTS Format
*Note any DISCREPANCY like wrong DOB*

JS 9/29/14 R1: Spoke with Stacy (Medical Records). I

was able to verify 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.

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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

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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: docmgt@episource.com
Your Schedule Due Date: 10/10/2014
Request for Medical Records
2 pages for Aetna
Sent to OCs personal fax # (efax)
Salesforce Generate Chart List
Export Details Export
Project Name
Provider
Members 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

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TOOLS

SEARCH ENGINES

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

Technician will go to the Providers office

Always VERIFY ADDRESS
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Corporate Team: Schedule via

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

Username
Password

Secure Data Transfer

Secure Email

Email: docmgt@episource.com

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

Admit, 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

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Aetna is transforming health care to create healthier communities, a healthier

nation and a healthier world. Let us show you how were 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 001139: infectious and parasitic diseases

List of ICD-9 codes 140239: neoplasms
List of ICD-9 codes 240279: endocrine, nutritional and metabolic diseases, and
immunity disorders

List of ICD-9 codes 280289: diseases of the blood and blood-forming organs

List of ICD-9 codes 290319: mental disorders

List of ICD-9 codes 320359: diseases of the nervous system

List of ICD-9 codes 360389: diseases of the sense organs

List of ICD-9 codes 390459: diseases of the circulatory system

List of ICD-9 codes 460519: diseases of the respiratory system

List of ICD-9 codes 520579: diseases of the digestive system

List of ICD-9 codes 580629: diseases of the genitourinary system

List of ICD-9 codes 630679: complications of pregnancy, childbirth, and the

puerperium
List of ICD-9 codes 680709: diseases of the skin and subcutaneous tissue
List of ICD-9 codes 710739: diseases of the musculoskeletal system and connective
tissue

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List of ICD-9 codes 740759: congenital anomalies

List of ICD-9 codes 760779: certain conditions originating in the perinatal period

List of ICD-9 codes 780799: symptoms, signs, and ill-defined conditions

List of ICD-9 codes 800999: injury and poisoning

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

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