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NaviNet Provider Portal Game
Lauren Carrillo
Created on March 27, 2023
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Transcript
NaviNet
Provider Portal Game
start
You arrive to the office, grab your coffee, and open your laptop. You are surprised to see an early email from your boss.
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Hi! Sorry to be emailing you so early, but we just received an urgent email from Dr. Smith requesting immediate training on NaviNet. Is this something you can get setup right away? Thanks!
Reply
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Hi! Yes, absolutely! Please see the below topics Dr. Smith and his team will be trained on next week: Thank you!
NaviNet Basics & Support
Eligibility & Benefits
Claim Status Inquiry & Investigation
Reports & Other Features
Medical Authorizations
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In order to prepare for your upcoming training with Dr. Smith and his team you will need to ensure that you are prepared to train on NaviNet Basics. Over the next few screens you are going to be asked a series of questions to test your knowledge on the NaviNet Basics.
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Once initially completed, how often will users be asked to confirm their roles and responsiblities?
Correct!
Once initially completed users will be asked to confirm their roles and responsibilities once a year.
Incorrect!
Once initially completed users will be asked to confirm their roles and responsibilities once a year.
Once a year
Once a week
They will never have to confirm
Every 90 days
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True or False: NaviNet has a robust Help and Support Page to assist the user with FAQs, Health Plan Information, Security Officer Information, and Training Videos.
Correct!
The correct response is true. NaviNet has a Robust Help and Support Page to the user with FAQs, Health Plan Information, Security Officer Information, and Training Videos.
Incorrect!
The correct response is true. NaviNet has a Robust Help andSupport Page to the user with FAQs, Health Plan Information, SecurityOfficer Information, and Training Videos.
False
True
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Which of these statements are true?
Correct!
The correct response is that users are required to reset their password every 90 days.
Incorrect!
The correct response is that users are required to reset their password every 90 days.
Users are required to reset their password every 90 days
Offices are permitted to have only one Security Officer
Providers should contact their AE with NaviNet support questions
You should always use the back button
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Which of these statements are false?
Correct!
The correct response is All of these statements are false.
Incorrect!
The correct response is All of these statements are false.
Providers can only chat with NaviNet Support
Providers will use the change profile screen
All of these statements are false
Users cannot see who their Security Officers are
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Once a user is on their plan central page, which workflow listed below is a provider able to select?
Correct!
The correct responise is that Providers can select all of these workflows.
Incorrect!
The correct responise is that Providers can select all of these workflows.
Claims Submission
Eligibility & Benefits
Claim Status Inquiry
Providers can select all of these workflows
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Basics & Support
Eligibility & Benefits
Claims Status Inquiry & Investigation
Reports & Other Features
Medical Authorizations
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Now that you know what the Eligibility & Benefits screen is suppose to look like, let's test your knowledge! Over the next few screens you are going to be asked a series of questions to test your knowledge on Eligbility & Benefits.
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True or False: If a member has active other insurance we can see the details of that plan on the Eligibility and Benefits screen?
Correct!
The correct response is true. If a member has active other insurance we can see the details of that plan on the Eligibility and Benefits screen.
Incorrect!
The correct response is true. If a member has active other insurance we can see the details of that plan on the Eligibility and Benefits screen.
False
True
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In the Patient Alert details box, what alerts can be available, when applicable, for the provider to review?
Correct!
The correct response is that Providers can access all of these alerts.
Incorrect!
The correct response is that Providers can access all of these alerts.
ADT Alerts
Outstanding Care Gaps
Redetermination Alerts
Providers can access all of these alerts
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Correct!
The correct response is false. We are able to see a prior year's history for a member.
Incorrect!
The correct response is false. We are able to see a prior year's history for a member.
True or False: We cannot see any prior year history for a member.
False
True
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Take a look at the below Hospital benefit: If a member goes to a hospital for services is an authorization required?
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Based on the benefit, Authorization would be REQUIRED.
Incorrect!
Based on the benefit, Authorization would be REQUIRED.
No Authorization is Required
Yes, Authorization is required
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Basics & Support
Eligibility & Benefits
Claims Status Inquiry & Investigation
Reports & Other Features
Medical Authorizations
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John Doe (123456789)
000000000
John Doe (123456789)
000000001
John Doe (123456789)
000000002
John Doe (123456789)
000000003
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Now that you know how to perform a Claims Status Inquiry & Investigation, let's test your knowledge! Over the next few screens you are going to be asked a series of questions to test your knowledge on Claims Status Inquiry & Investigation.
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True or False: In order to perform a Claim Status Investigation a claim must be in a finalized status.
Correct!
The correct response is true. a claim must be in a finalized status in order to perform a claim investigation.
Incorrect!
The correct response is true. A claim must be in a finalized status in order to perform a claim investigation.
False
True
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When looking at a Claims Status where is the view ERA link available?
Correct!
The View ERA link is available under the Additional Information section.
Incorrect!
The View ERA link is available under the Additional Information section.
Insurance Details
Billed Amount
Additional Information
Claim and Service Line Details
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True or False: Notifications WILL be sent to the provider via email.
Correct!
The correct response is false. The provider is required to put their email address, but notifications WILL NOT be sent via email.
Incorrect!
The correct response is false. The provider is required to put their email address, but notifications WILL NOT be sent via email.
False
True
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Which of the below reasons is not listed in the drop list when performing a claims investigation?
Correct!
The correct response is All of these reasons are listed in the drop down list.
Incorrect!
The correct response is All of these reasons are listed in the drop down list.
Timely Filing Issue
Patient Liability
TPL Eligibility
All of these are listed in the drop down list
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Basics & Support
Eligibility & Benefits
Claims Status Inquiry & Investigation
Reports & Other Features
Medical Authorizations
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Administrative
Clinical
Member Clinical Summary
Financial
Member Clinical Summary Report:This report provides a snapshot of personal health information such as:
- Patient Demographics
- Provider Demographics
- Chronic Conditions
- Gaps in Care
- ER Visits
- Inpatient Admission
Claims Status Summary: This report allows the provider to request a full claim status report. Panel Roster: Providers can run a Panel Roster report at the group level, or at the individual doctor level. Authorization Status Summary: This report allows the provider to request an authorization summary without having to pull up individual members.
Care Gap Query: This is a customizable report that provides care gap information for members in the providers practice. Member Alert Standalone Care Gap Request: Allows access to a singular members Care Gap information. Admit Report: A report of members admitted to the hospital will be generated.
There are a few different financial reports available that vary by LOB:
- Adjusted Claims Report Query
- HEDIS QEP Report
- Prospective Outreach Payment Report
* Click on each green header
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Now that we have learned about the Reports Inquiry, let's test your knowledge! Over the next few screens you are going to be asked a series of questions to test your knowledge on Reports Inquiry.
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Take a look at the report name below and select the answer in which section this report can be found?
Correct!
This report is in the Administrative Reports section.
Incorrect!
This report is in the Administrative Reports section.
Authorization Status Summary
Administrative Report
Financial Report
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True or False: Providers can only run a Panel Roster Report at the group level.
Incorrect!
The correct response is false. Providers can run a Panel Roster Report at the group level and at the individual doctor level.
Correct!
The correct response is false. Providers can run a Panel Roster Report at the group level and at the individual doctor level.
True
False
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Take a look at the report name below and select the answer in which section this report can be found?
Correct!
This report is in the Clinical Reports section.
Incorrect!
This report is in the Clinical Reports section.
Care Gap Query
Clinical Report
Administrative Report
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True or False: The Member Clinical Summary Report provides a snapshot of personal health information?
Correct!
The correct response is true. This report does show a snapshot of a members personal health information.
Incorrect!
The correct response is true. This report does show a snapshot of a members personal health information.
False
True
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Basics & Support
Eligibility & Benefits
Claims Status Inquiry & Investigation
Reports & Other Features
Medical Authorizations
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The final item on your Training Checklist is Medical Authorizations. Over the next few screens you are going to be asked a series of questions to test your knowledge on Medical Authorizations.
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Take a look at the photo below, which selection would allow the provider to start a new authorization?
Correct!
A provider can start a new authorization under Medical Authorizations.
Incorrect!
A provider can start a new authorization under Medical Authorizations.
Medical Authorizations
Medical Authorizations Log
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If a provider wants to pause their authorization request to come back to it at a later time, which option would they select?
Correct!
The correct response is Save as Draft.
Incorrect!
The correct response is Save as Draft.
Discard Auth
Save as Draft
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What does the Requesting Provider do?
Correct!
The Requesting Provider is the one who is requesting service(s) be provided.
Incorrect!
The Requesting Provider is the one who is requesting service(s) be provided.
They are completing the service(s) being requested
They are requesting the service(s) being requested
They do not do anything
They are the members PCP
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Fill in the blank: To search for an existing authorization, the provider can search by the ___________ or _______________ provider.
Correct!
Providers can search for an existing authorization by the Requesting or Servicing provider.
Incorrect!
Providers can search for an existing authorization by the Requesting or Servicing provider.
Inpatient and Outpatient
Elective and Urgent
Requesting or Servicing
None of the Above
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Basics & Support
Eligibility & Benefits
Claims Status Inquiry & Investigation
Reports & Other Features
Medical Authorizations