We are reassigning this task to Intake, effective 5.24.24.  Here's an explanation of the task and how Intake should approach it.  

Physician PECOS verification task reassignment

This task is currently assigned to the BILLING SPECIALIST role at the Support Center (home office).  We are reassigning it from the billing specialist to HH INTAKE next week. 

Why?

Superusers and Intake are the positions that verify PECOS enrollment when they add providers to HCHB, not the billing specialists.  Also, this task generates before the SOC and holds up the scheduler’s ASSIGN LP task, so we wanted to assign it to an agency position instead of a Support Center (home office) position. 

When will this task generate?

Only when HCHB detects that a patient’s provider is not PECOS enrolled at the time the referral is completed. 

Workflow order: 

Referral completed > Obtain initial auth/Verify Medicare Eligibility > Physician PECOS Verification > Review Eligibility Alert > Assign LP

How to complete this task

1.       Open the task and scroll to the right to view the enrollment status details.

2.       Based on the enrollment status, either complete the task, make a change, or non-admit the patient.

a.       Verified, or Verified – Legal Name Mismatch Approved

                                                               i.      NO ACTION NEEDED.  STAGE COMPLETE THE TASK.

b.       Not Verified – Legal Name Mismatch

                                                               i.      Click View/Update Physician PECOS Status to match their HCHB name to the CMS database, then stage complete the task.

c.       Not Verified, or Not Verified – Enrollment Pending

                                                               i.      Click Link To CMS PECOS Physician list to review their status at the CMS website.

 

 

 If they’re showing as PECOS enrolled there (Y in the HHA column), there is no further action to take – you can just stage complete the task.  If the provider is NOT showing as PECOS enrolled in the CMS database (N in the HHA column), cancel out of the task and call the provider to see what can be done. 

·         They may have proof that they are PECOS enrolled.

o   If this is the case, once you receive the proof, add it to the patient’s attachments, then reopen the task and stage complete it.  Add a coordination note to let your team know that we have proof of PECOS enrollment attached, but the CMS database just hasn’t been updated as of that date, and that it’s ok to continue with the provider. 

·         There may be another provider in the same office that is PECOS enrolled and willing to co-sign for the patient. 

o   If this is the case, edit the referral to correct the provider.  Add a coordination note to explain the situation.  Once the non-PECOS enrolled provider is removed the task should auto-clear. 

·         If the above 2 options aren’t available, consult with the clinical manager.  If there are no other options, open the task and non-admit the patient.