GENEDX OUTBOUND REFRESHER
Quiz by Jesryl Bucol
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- Q1
Which statement is correct?
If the pt has Medicaid, the reps should provide the EOOP. If the pt has Medicare Advantage, we will not activate the test as Prior Auth is needed.
If the patient has Medicare as primary and Commercial plan as secondary, the reps should activate the test. If the pt has a Medicaid plan as primary and Straight Medicare as secondary, the reps should provide the EOOP to the patient. If the pt has a Commercial plan as the primary and secondary plan, the reps should not activate the test as ABN is needed.
If the patient has Medicare as primary and Medicaid as secondary, the reps should activate the test as long as it is both active during the DOS. If the pt has a Commercial plan as primary and Straight Medicare as secondary, the reps should provide the EOOP to the patient. If the pt has Straight Medicare, the reps will not activate the test because ABN is needed. If the rep has Straight Medicare as primary and Tricare as secondary, the reps should activate the test for $0 as long as it is both active on the DOS.
120s - Q2
Which statement is correct?
If the accession is on the AIM list, but the prev notes from Onshore state that it is a confirmed not an AIM payer and no PA indication, the reps should skip the accession and move to the next leads.
If the accession is on the AIM list, but the prev notes from Onshore state that it is a confirmed not an AIM payer and no PA indication, the reps should conduct BI and wait for the PA decision.
If the accession is on the AIM list, but the prev notes from Onshore state that it is a confirmed not an AIM payer and no PA indication, the reps should conduct BI and activate the test if EOOP is less than $100 or call the patient if the EOOP is more than $100.
120s - Q3
For AETNA payers.
What self-pay amount should we provide to the patient if the PA was denied for test code 690B, and the client is Invision Health, with Dr. Julian Ambrus as the ordering provider?
$1500
$100
$250
$2500
120s - Q4
Which statement is correct?
If the pt is still undecided with the testing and advised you that they will just call us back. The reps should move the accession to the next queue (second, third contact) until the pt agreed to activate the test.
If the pt is still undecided with the testing and advised you that they will just call us back. The reps should cancel the testing.
If the pt is still undecided with the testing and advised you that they will just call us back. The reps should move the accession to Final Contact and wait for their callback/wait for 30 days before we cancel the test.
120s - Q5
Which is the correct hierarchy when doing a BI for fresh leads?
PET - Payor Call - UHC/Availity/Navinet/UMR
Admin Portal - PET - UHC/Availity/Navinet/UMR - Payor Call
Admin Portal - PET - Payor Call - UHC/Availity/Navinet/UMR
120s - Q6
What will you do if the patient advised you that they have received the PA approval but it is not posted in RPM?
The reps should advise the pt that we will activate the test since she already received the PA approval.
The reps should advise the pt to send us a copy of the approval or ask for the authorization number and send it to billing@genedx.com to update the account.
The reps should advise the pt to disregard it since we haven't received the approval yet.
120s - Q7
If the pt asks for the turnaround time of the test, the reps should
Educate the rep with the turnaround time using the GeneDx website.
Offer to transfer the call to technical Customer Service and dial 888-729-1206 opt 3.
Advise them that you are not allowed to give the turnaround time since it is not included in your scope.
120s - Q8
When updating an accession with insurance information
Update all the accessions under the same requisition and do not remove the EPI number.
Make sure to update all the associated accessions under the requisition. Remove the EPI number to prevent the demosweeper from switching it back to the old insurance information.
Update the primary accession and do not work on the associated accessions.
120s - Q9
Which statement is correct?
If the accession is confirmed an AIM payer and PA is still pending, the reps should activate the test if the EOOP is less than $100.
If the accession is confirmed an AIM payer and PA is still pending, the reps should conduct BI, but will pend the activation or patient call until we received the PA decision.
If the accession is confirmed an AIM payer and PA is still pending, the reps should skip the accession.
If the accession is confirmed an AIM payer and PA is still pending, the reps should call the patient to offer the self-pay price.
120s