Chapter 21. Consumer Enrollment Process
In order to process a claim, the Medicare provider partner will need the insurance information for each participating beneficiary, along with each person’s supplemental insurance information. This information should be captured when a consumer is identified as a potential participant in a DSMT class. If this intake occurs at the AAA, then the AAA should be trained on the Medicare provider partner’s intake process. This will include having copies of the forms and other authorizations required to complete the registration process. If the Medicare provider partner is using an electronic medical record, then the AAA will need access to the EMR system to enter information on each potential participant. Electronic access to the Medicare provider partner’s system can occur via Internet for cloud-based systems, or through a virtual private network (VPN), for server based systems, so that information can be entered directly into the Medicare provider partner’s system. The process of verifying consumer information and entering it into the Medicare provider partner’s system will require staff training. The Medicare provider partner will be responsible for coordinating the training for AAA staff. Any system licensure issues will be the responsibility of the Medicare provider partner. If system access requires the Internet, then both organizations must implement a plan to ensure Internet access at all locations where services will be rendered. The Internet access can occur via Wi-Fi or wireless devices. Cloud-based systems and VPN access provides adequate security for consumer intake in remote locations.
** The information obtained during the intake process is protected health information (PHI) and subject to HIPAA regulations. Any identifying information about a consumer must be protected. In general, no patient information can be shared via regular e-mail. This includes internal e-mail. You must have a special e-mail encryption service in order to send any patient information over e-mail.
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