HIPAA Verification & Authentication

Select ALL that applies:

Which of the following below are considered to be a PHI identifiers?

• Patient's DOB

• Patient's Medical Records

• Patient's Bank Account

• Patient's Claims History

• Patient's Full Name

The caller says Richie Dela Cruz. What we have on our System is Richard Dela Cruz. Is this an acceptable and reasonable match?

• Yes

• No

• Maybe

Let's say you are done with the first member, you informed the caller about his inquiry. However, the caller would like to inquire another member he has on his end. What should you do?

• Ask the caller if that is still under the verified provider?

• Proceed with the call and simply ask the Member information since provider has been verified.

• Proceed with the call no need for any additional verification.

The name we have on our system is Kyle Martinez II. However, the caller mentioned Kyle Martinez, do we accept this one?

• Yes, so long the date of birth is matching to what we have on file.

• No, we have to ask again the Member's ID, Name, and DOB.

• Yes, so long Kyle Martinez is on our system this should be good.

• No, we still need the suffix of Kyle.

What are the two types of source systems that NATDOM and Central Local NORMALLY handled for the Member's Account?

• WGS

• SPS

• NASCO

• COMPOSITE

• GBD

ACMS says: CHRISTOPHER DE LEON

Provider says: Topher Dela Cruz

Do we accept?

• No

• Yes

• Maybe

ACMS says: Christopher De Leon

Provider Says: Topher De Leon

Do we accept?

• Yes

• No

• Maybe

ACMS says Dominique Angelo

Provider says Domineek Angelo

Do we accept?

• Yes

• No

• Maybe

If we have received a call from the other department, they have mentioned that they are coming from Anthem, Elevance Health, and Intake. How do you verify the agent from the other line? Select all verifications that might be needed.

• Collect the associate's full name and their department name

• If the associate is not comfortable providing his/her full name. We can collect ANTHEM ID. Then, verify in the system.

• There is no need to verify the associate. We just verify the provider and member information. Then, proceed on the call.

• Authenticate the account.

What we have on the ACMS says Charmaine Trace Green. Then, the caller mentioned Trace Green. Should we accept it?

• Yes

• No

• Maybe