PAYOR CHANGE QUIZ

2. What is the process for patients undergoing wrong payor source code at SOC?

A. Enter APCLO and put the account on BILL Hold

B. Entering Payor Change Team Only – Informational Only note

C. Entering Scheduler Notification and UAR to discharge and re-admit

D. Adding Additional Primary Payor

1. Where we need to do a Payor Change Process?

A. If the Payor is changing in the future

B. If there is a billable visit made under the new Payor

C. If there are no visits made under the new Payor

D. If the patient will stay under the same plan and group #

3. In all of these scenarios, we need to enter Patient Information Updated (regarding benefits change) except,

Mid Payor Changed from UHC Navihealth MA to UHC Navihealth DSNP or vice versa

Mid Payor Changed from UHC Navihealth MA to UHC TN/FL DSNP or vice versa

Mid Payor Changed from Medicare Palmetto to UHC Navihealth

Mid Payor Changed from UHC Navihealth to Other Insurance

4. In all of these scenarios, we need to enter PAYORMOVE authorizations, except

A. Mid Payor Changed from Medicare Palmetto to UHC Navihealth

B. Mid Payor Changed from UHC Navihealth to Other Insurance

C. Mid Payor Changed from UHC Navihealth to TN/FL DSNP

D. Mid Payor Changed from UHC Navihealth to Optum

5. What is the Payor Code we use if the plan is under TN DSNP

A. UHC.NAVIHEALTH.DSNP.MA.C.AUTH

B. UHC.SE.DSNP.MA.C.AUTH

C. UHC.SE.TN.DUAL.MA.C.AUTH

D. UHC.OH.TX.OK.EVOL.NAVIHEALTH.DUAL.MA.C.AUTH

6. What is the Payor Code we use if the plan is under FL DSNP

A. UHC.NAVIHEALTH.DSNP.MA.C.AUTH

B. UHC.SE.DSNP.MA.C.AUTH

C. UHC.SE.TN.DUAL.MA.C.AUTH

D. UHC.OH.TX.OK.EVOL.NAVIHEALTH.DUAL.MA.C.AUTH

7. We use Payor Change Team Only – Informational Only coordination notes for these cases, except

A. Mid Payor Changed from UHC Navihealth MA to UHC Navihealth DSNP or vice versa

B. Group # Changed from Navihealth MA to another Navihealth MA

C. Both Group # and Policy # Changed from Navihealth MA to another Navihealth MA

D. Mid Payor Changed from Navihealth MA to Humana

8. If an Admission Communication Notes was received regarding Payor Change, we need to enter “PAYOR SOURCE CHANGE REQUEST – ADMISSIONS” and remove the Canned text to what coordination note?

A. Urgent Admission Request

B. Payor Change Team Only Informational Only

C. APCLO

D. Patient Information Updated

9. All of these additional processes are being done when a PAYORMOVE was entered, except

A. Auth to Auth move

B. Changing the end date of the previous authorization

C. Adding pending quantity equivalent to the visit plotted to the calendar from the payor change date up to the end of episode

D. Adding Additional Primary for the New Payor Code

10. If there is a Mid Payor changed from UHC Navihealth plan to HUMANA, what are we going to do with the PENDING episode?

A. Change the payor code to ADMISSIONS.CODEREQUEST.ACSPRONAVIHEALTH.AUTH

B. Change the payor code to ADMISSIONS.CODEREQUEST.HUM.AUTH

C. Change the payor code to ADMISSIONS.CODEREQUEST.UHC.AUTH

D. Change to actual HUMANA Payor Code

PAYOR CHANGE QUIZ

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