GNMS: Outpatient Inquiries Summary

An office visit is usually:

• A consultation at a medical provider's office.

• A visit at the hospital.

• Colorguard

• A procedure such as a biopsy, CT Scam, or minor surgery.

Why is it important to understand that office visits may include additional services such as X-rays and labs?

• To ensure the provider is paid.

• To provide accurate quotes.

• To provide the next level of service to our members.

• To help doctors provide good care.

Which article was mentioned about virtual visits?

• ABCs of telehealth

• Guidelines for Quoting Benefits

• ProcedureFlow article: Telehealth

• ACE article: Virtual Visits (Telehealth)

When do you choose Office Services for the question "What does the caller need?"

• When the caller knows that they will only have a consultation with the doctor and no other services.

• When the provider category is Professional.

• When the caller is unsure if they need other services during their office visit.

• When the caller states that they will have labs, or other services, during their office visit.

When providing quotes, always:

• Start with the primary service and quote from the top down.

• Start with secondary services and quote from the bottom up.

• Checkmark all benefits, even if you did not provide the related quote.

• Review all benefit hyperlinks, if available.

You only have to quote in-network benefits.

• True

• False

Answer explanation

True! But you must quote the disclaimer shown in red on RTB or an error will be cited.

For a virtual visit, what do you typically choose for the question "What does the caller need?"

• Telehealth (Telemedicine) Services

• Office Services

• Office Visit

• Consultation

When providing quotes and there is no maximum for a service, you should:

• Skip that benefit and don't checkmark that benefit.

• State that there is no maximum and checkmark that benefit line.

• Skip that benefit but still checkmark that benefit line.

• State that there is no maximum but don't checkmark that benefit line.