AGS and the Centralized Funding Team are currently responsible for portions of more than half of the orders in Funding. To ensure a smooth process for our clients, branches, and funding team, it is important to partner with one another. The division funding team, centralized funding team, and AGS all work together for a common goal, to improve the lives our clients by delivering the best solutions possible.
 
It can be difficult to adapt to a new process that is compartmentalized. Think of the funding process as a baton race. While you are holding the baton (the order is with you), do all you can to ensure the order is ready for the hand off to next team member. This requires us to be extremely thorough and timely.
 
AGS and the Centralized Funding team have unique roles that are specific to solely working with the payer(s) on a work order. There is no client communication or communication with physicians, therapists, manufacturers, branch staff etc. This requires AGS and the Centralized Funding team to rely on Division Funding for all documents and demographics. They also have a restricted view of Mobility Advisor. This limits their ability to correct a physician or therapist in a work order.
 
Over the last few months, we’ve identified trends that cause significant delay and confusion for our partners. By quality actions, we can improve our transaction cycle time, reduce FARs (Funding Action Required), reduce deferrals and denials, and prevent unnecessary rework.
 

Please be mindful of the following:

• Mark documents satisfied when the document is received and labeled properly in Scan Docs. The documents below are commonly satisfied but missing from Scan Docs. This will result in a FAR or a Deferral.
  • Insurance cards - This is not a copy of the eligibility. This is required to ensure BCBS Plans and some UHC delegated groups are submitted correctly.
  • Accurate proof of pricing as mandated by the Payer, i.e., MSRP only quotes, MSRP order forms and/or Manufacturer Cost quotes.
  • ATP Evaluation
  • ATP Certification
• Ensure the NPI Borrowing tool is set up correctly on the Main Screen for branches that must borrow for in network status.
• Most common incomplete or incorrect documents
  • Financial Attestation: The therapist listed on the work order does not match the Therapist on the LMN and the form is missing the Medicare ID#/Payer ID#.
  • The STAT section in Mobility Advisor is incomplete so Medicare/Medicaid ID # does not pull to our forms correct such as the PA Form, certain RX forms, Financial Attestation, etc. OR the payers listed in the client’s demographic screen does not match Payers 1-3 on the work order, so the ID#’s will not pull correctly.
  • Some documents scanned and labeled only contain a signature page and not the whole document. The whole document is necessary to fulfill the pay rule. This is required to merge documents for a successful and accurate Funding Packet.
  • The document (Rx, LMN, CMN, etc.) does not match the physician in Mobility Advisor so incorrect physician/practitioner pulls to system generated forms.
  • CMN/RX’s missing vital Provider ID information.
• Close a FAR (Funding Action Required) only when all issues are resolved. Please remember to be professional and thorough in your notes. When a Pending FAR is open, an S Document will not stop an order from moving back to AGS and the Centralized Funding Team. An S document will only stop an order from returning to the Ready to Submit queue (workstream).
• Ensure the pay rules are labeled correctly for the individual work order. If you know there are additional documents that must be in the Funding Packet, please label them as an S document and ensure they are clearly labeled in Scan Docs.
• Contact your Funding Leader when you notice the UPD is incomplete or inaccurate.
  • Does the UPD list the required PA form? Are there any specific instructions for this form?
  • Are the pay rules (S, P, and D documents) accurate?
  • What version of the NSM Quote is required to be used in the Funding Packet?
• If you notice an error such as an invalid FAR (Funding Action Required), please report to your Funding Leader. Your Funding Leader will work with Leadership to retrain, correct the concern to prevent it from reoccurring.

National Seating & Mobility remains dedicated to our clients regardless of the internal changes in process. Thank you for being part of the solution.