thorntree wrote on Wednesday, November 28, 2007:
This thread has been started to discuss the precertification module.
(I have currently emailed the files to ROD) if anyone else needs them, let me know and then give me feedback or you make your changes and add to code. Whatever works.
In brief
The process flow is as follows:
Step 1: or Form 1: called the "clearance form",
The physician or nurse will request a precert for certain procedures for a patient.
Step 2: or Form 2: called the "clearance checking form"
The staff will access the form and act on each item on the list.
When the PID is clicked, a new window opens up which has all relevant details to call the insurance company as well as clearance related fields to assist the STAFF in completing the form and providing information to the insurance company.
The choices will be: either NPCR or no precert required, or predetermination required so send notes or they will precertify it and provide some authorization code.
This will be logged and if NPCR then it will be moved from the clearance list.
If predetermination is required then it will be FLAGGED with RED flag in the list so the person knows that some documents need to be sent.
additional sub modules:
TRICARE:
Using the information the physician fills into the 1st form, we automatically generate a tricare preauthorization form to avoid double data entry.
This form just needs to be glanced over as mostly it does not require amends and can be faxed directly to tricare using your fax modem. At this time tricare does not accept email-to-fax on that number.
Else originally we had configured it to email it to tricare fax as PDF.
In anycase, a pdf of the tricare request comes to us via email.