build a software IVR system

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timer Asked: Jan 29th, 2021

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build a software system as a finals school project. It is very complex and detail oriented. Need expert level help asap. Please and thank you. Will give details when I find the right person for hire.

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INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE MODULE Interactive Voice Response System LIBRARY REFERENCE NUMBER: PROMOD00002 PUBLISHED: JANUARY 21, 2020 POLICIES AND PROCEDURES AS OF NOVEMBER 1, 2019 VERSION: 4.0 © Copyright 2020 DXC Technology Company. All rights reserved. Revision History Version Date Reason for Revisions Completed By 1.0 Policies and procedures as of October 1, 2015 Published: February 25, 2016 New document FSSA and HPE 1.1 Policies and procedures as of February 13, 2017 Published: May 11, 2017 Scheduled update FSSA and HPE 2.0 Policies and procedures as of October 1, 2017 Published: January 11, 2018 Scheduled update FSSA and DXC 3.0 Policies and procedures as of October 1, 2018 Published: December 18, 2018 Scheduled update FSSA and DXC 4.0 Policies and procedures as of November 1, 2019 Published: January 21, 2020 Scheduled update:  Edited text as needed for clarity  Updated the initial note box with standard wording  Clarified information in the Entering Alphabetic Data section  Updated option 5 in step 1a of Table 7 – IVR System Initial Options  Updated step 5-8d of Table 9 – IVR System – Service Restrictions to remove the note about the IVR system not returning benefit limit information for managed care members  Removed the limit on the number of coverage types returned in the Other Insurance Information section  In the Benefit Limits section, updated the benefit limit information provided by the IVR system FSSA and DXC Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 iii Table of Contents Introduction ................................................................................................................................ 1 How to Use the IVR System ...................................................................................................... 1 IVR System Limitations ..................................................................................................... 2 Quick-Entry Techniques ..................................................................................................... 2 Entering Alphabetic Data .................................................................................................... 2 Error Messages ................................................................................................................... 3 IVR System Walkthrough .......................................................................................................... 5 Initial Options for the IVR System – Introduction and NPI or Provider ID Validation ...... 6 Member Eligibility .............................................................................................................. 9 Benefit Limits ................................................................................................................... 17 EFT/RA Payment Inquiry ................................................................................................. 20 Prior Authorization Inquiry ............................................................................................... 20 Claim Status Inquiry ......................................................................................................... 27 Provider Enrollment Information ...................................................................................... 31 Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 v Interactive Voice Response System Note: The system described in this module provides limited information regarding managed care programs, including Healthy Indiana Plan (HIP), Hoosier Care Connect, and Hoosier Healthwise. The managed care entities (MCEs) are responsible for supplying providers with this information for services delivered to their assigned members. For MCE contact information, see the IHCP Quick Reference Guide available at in.gov/medicaid/providers. For updates to the information in this module, see IHCP Banner Pages and Bulletins at in.gov/medicaid/providers. Introduction The purpose of the Interactive Voice Response (IVR) system is to help Indiana Health Coverage Programs (IHCP) providers obtain member-related information through the use of a touch-tone telephone. The IVR system is a self-service application and should be used as the first line of resolution for routine provider questions. Through a series of prompts and responses, the IVR system allows providers to query by entering data using the telephone keypad. System information is then shared via a computerized voice response system. The IVR system is capable of handling multiple calls simultaneously and is available 7 days a week, 24 hours per day. All information obtained from the IVR system is protected personal health information. The IVR system provides the following information:  Member eligibility (including coverage, restrictions, and other insurance) for all IHCP members, including managed care  Benefit limitations for fee-for-service (FFS) members  Check and electronic funds transfer (EFT) payments from DXC Technology – FFS claims only  Prior authorization (PA) status for FFS requests  Claim status for FFS claims  IHCP provider enrollment application status Enrolled providers can also make Affordable Care Act (ACA) revalidation payments using the IVR system. How to Use the IVR System The IVR system is accessed by calling the toll-free IHCP customer assistance telephone number, 1-800-457-4584, and selecting Option 2 followed by Option 5. The IVR system then asks providers to enter a National Provider Identifier (NPI) that has been reported to the IHCP or an IHCP-issued Provider ID. Providers must have a touch-tone telephone to access the IVR system. Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 1 Interactive Voice Response System IVR System Limitations There is no limit to the number of calls a provider can make to the IVR system. However, the IVR system does have certain limitations:  The IVR system limits the number of attempts allowed for entering information correctly. After three unsuccessful attempts, the system transfers the call to a customer service representative.  The provider is allowed 6 seconds to enter data after receiving an IVR system prompt. After 6 seconds, the system reminds the caller to enter the requested data. If information is not entered within 6 seconds after the third prompt, the system transfers the caller to a customer service representative.  The IVR system provides information for up three PA request line items per inquiry. If additional PA information is available, the caller is given the option to speak with a customer service representative. Information for all PA requests (not limited to three line items) is also available on the Portal. Quick-Entry Techniques As providers become more familiar with the IVR system, they can enter information more quickly using the techniques in Table 1. Table 1 – IVR System Quick-Entry Techniques Speed Entry Explanation Entering information before IVR system finishes speaking The IVR system allows keystrokes to be entered over prompt messages. It is not necessary to listen to the entire message before entering a response. A good technique is to listen to the first word or two of the prompts and then begin entering information. By listening to the first part of the prompt, you verify that you are entering the correct data. Starting a new transaction for the same member After an IVR eligibility or benefit limit transaction is completed, to return to the main menu and perform another transaction for the same IHCP Member ID (also known as RID), press 2 (after an eligibility inquiry) or 3 (after a benefit limit inquiry) instead of re-entering the Member ID. Entering the from and to dates of service To use the current date as the from date of service, press  when prompted to enter the from date of service. To use the from date of service as the to date of service, press # when prompted to enter the to date of service. Completing an entry Always press  after entering data at a prompt. Pressing  provides the fastest response from the system. Entering Alphabetic Data The IVR system requires numeric information; therefore, any alphabetic data, such as an alphabetic character in a taxonomy code or Provider ID, must be converted to numeric data. To convert an alphabetic character into a numeric code, follow these steps: 1. Press *. 2. Next, press the number on the telephone keypad (2–9) that contains the desired letter of the alphabet. For example, press 2 for letters A, B, or C, because those letters all appear on the number 2 key. (Exception: For letters Q or Z, press 1.) 2 Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 Interactive Voice Response System 3. Then press the number (1, 2, or 3) that corresponds to the position of the desired letter on the key. For example, press 1 for A, 2 for B, or 3 for C, because letters A, B, and C are in positions 1, 2, and 3, respectively, on the number 2 key. (Exception: For letter Q, press 1. For letter Z, press 2. If your keypad includes the letter Q, disregard that letter when determining the position of the other letters on that key.) Note: The IVR system’s alphanumeric translation formula assumes that the letters Q and Z do not appear on the keypad. For phones that do include Q and Z on the numbered keys, continue to follow the instructions in the preceding steps for letters Q and Z, and disregard those letters in determining positions of other letters. For example, if the 7 key has the letters P Q R S, disregard the Q and consider R to be in the second position and S to be in the third position. See Table 2 for the correct key combinations for all letters. Example 1 – Converting A to a numeric code: A corresponds with the number 2 key. A is in the first position among the alphabetic characters on the number 2 key (A B C). Enter  2 1 to designate the letter A. Example 2 – Converting Q or Z to a numeric code: Because the letters Q and Z are not found on some telephone keypads, to convert these letters to a numeric code, do the following: Enter  1 1 to designate the letter Q. Enter  1 2 to designate the letter Z. Table 2 shows how to translate each alphabetic character into a numeric data for the IVR system. Table 2 – Alphabetic Data to Numeric Data Translation Letter Enter Letter Enter Letter Enter A 21 J 51 S 73 B 22 K 52 T 81 C 23 L 53 U 82 D 31 M 61 V 83 E 32 N 62 W 91 F 33 O 63 X 92 G 41 P 71 Y *93 H 42 Q 11 Z 12 I 43 R 72 Error Messages Several categories of messages are used throughout the system. The information shown in Tables 3 through 6 can be used as reference tools if the IVR system returns an error message. Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 3 Interactive Voice Response System Table 3 – General IVR Error Messages When the IVR system says this... ...this is the problem: “Invalid data. Please re-enter.” A keystroke was entered that the IVR system did not recognize. Check the information and re-enter it. “Please wait while the requested information is retrieved.” The host computer requires a certain amount of time to respond to a request. This message is given while information is being retrieved. “Please hold your call is being transferred.” The caller will be transferred to a customer service representative for one of the following reasons:  The IVR system is currently unavailable or unable to process the request.  After three attempts, the information expected was not entered.  It has taken too long to enter the requested information. The IVR system allows three user timeouts (6 seconds each) to enter the requested data. Table 4 – Provider ID, NPI, ZIP Code, and Taxonomy IVR Error Messages When the IVR system says this… …this is the problem: “Invalid provider number [DATA ENTERED]. Please re-enter.” The Provider ID entered is not in the correct format. The Provider ID must be at least nine digits in length, plus, for some providers, one alphabetic character (see Table 2). “Invalid data [DATA ENTERED]. Please re-enter.” The NPI entered is not in the correct format. The NPI must be 10 digits in length and cannot include non-numeric keys. The service location ZIP Code entered is not in the correct format. The ZIP Code must be nine digits in length and cannot include non-numeric keys. The taxonomy entered is not in the correct format. The taxonomy must be 10 alphanumeric characters. Table 5 – Member Identification IVR Error Messages When the IVR system says this… 4 …this is the problem: “Invalid member RID number [NUMBER ENTERED]. Please reenter.” The Member ID (RID) entered is not in the correct format, or a non-numeric key was used while entering the number. “Invalid Social Security number [NUMBER ENTERED]. Please reenter.” The Social Security number (SSN) entered is not in the correct format, or a non-numeric key was used while entering the number. “Invalid date of birth number [DATE ENTERED]. Please re-enter.” The date of birth entered is not in the correct format, or a non-numeric key was used while entering the number. Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 Interactive Voice Response System Table 6 – Date IVR Error Messages When the IVR system says this... ...this is the problem: “Invalid from date of service [DATE ENTERED]. Please re-enter.” The from date of service entered is not in the correct format, or the date entered does not exist. Check the date and re-enter it in MMDDYYYY format. Example: October 1, 2019, is entered as 10012019. “Invalid to date of service [DATE ENTERED]. Please re-enter.” The to date of service entered is not in the correct format, or the date entered does not exist. Check the date and reenter it in MMDDYYYY format. Example: October 5, 2019, is entered as 10052019. “Invalid dates of service entered. The from date of service is greater than the to date of service.” The to date of service entered is before the from date of service. Check the dates and re-enter. “Invalid dates of service entered. The from date of service and the to date of service need to be in the same month.” The dates of service entered are not in the same calendar month. Check the dates and re-enter. “Invalid dates of service entered. Dates of service cannot be greater than today’s date.” The dates of service entered are in the future. Check the dates and re-enter. IVR System Walkthrough The following pages provide a step-by-step walkthrough of data entry and possible responses provided by the IVR system. The IVR system is reached by calling 1-800-457-4584. Providers should have relevant information available when dialing in, because the system has time and attempt limits for data entry:  IHCP Provider ID or NPI; if NPI is used, the following are also required: – ZIP Code + 4 (nine digits) of the provider’s service location – Taxonomy code that was reported with the NPI to the IHCP Note: Providing the nine-digit service location ZIP Code and, if necessary, the taxonomy code may assist the system in making a one-to-one NPI-to-Provider ID match. In most cases, the NPI plus nine-digit ZIP Code achieves a one-to-one match to a unique Provider ID.  Member ID (also known as RID) or SSN and birth date of the member (Required for eligibility inquiries.)  From and to dates of service, if applicable  PA number or PA start date, if applicable (Not required. PA inquiries may be conducted by Member ID only; however, only PAs that were requested by the provider conducting the inquiry will be returned.)  Internal control number (ICN)/Claim ID, if applicable (Not required. Claim inquiries may be conducted by Member ID, claim type, and date of service only. The system only returns information for claims submitted by the provider conducting the inquiry.)  Application tracking number (ATN) and taxpayer identification number (tax ID) (For enrollment status inquiries only.) Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 5 Interactive Voice Response System Initial Options for the IVR System – Introduction and NPI or Provider ID Validation Table 7 shows the options that are first encountered when using the IVR system. The information the provider is asked to enter depends on whether the provider uses an NPI or IHCP Provider ID. Table 7 – IVR System Initial Options Step Step 1a – Initial greeting 6 When the IVR system says this... “Welcome to the Indiana Health Coverage Program. Please listen carefully as our menu options have changed:  If you are calling for information on member, press 1.  If you are a doctor or medical service provider, press 2.  For EDI trading partner or Provider Healthcare Portal technical assistance, press 3.  For Medicare Buy-in, press 4.  For electronic visit verification support, press 5.  For Third Party Liability or Medicare, press 6.  Para usar este sistema en español presione 7.  To repeat this menu, press star.” …you do this: Press 2 for provider services options. Continue to Step 1b. Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of November 1, 2019 Version: 4.0 Interactive Voice Response System …you do this: Step When the IVR system says this... Step 1b – Access the IVR “Thank you for calling Indiana Health Coverage Programs provider services line. For your convenience, many inquiries can also be handled using the interactive Indiana Healthcare Portal at www.indianamedicaid.com. From the web site’s home page, select the Providers link. Follow the prompts to establish a user ID and password or log on if you are a current user. At any time during this call, you may press the star key to repeat the menu prompt. Please listen carefully as our menu options have changed:  If you are a member and have reached the provider services phone line in error, press 1.  If you are a provider inquiring about pharmacy services, press 2.  If you are calling for information on becoming an Indiana Health Coverage Program provider or to update your current enrollment information, press 3.  For EDI trading partner or Provider Healthcare Portal technical assistance, press 4.  For all other provider inquiries, press 5. Please have pen and paper ready to take notes.  Para usar el sistema en español presione 6.  To repeat this menu, press star.” Press 5 to initiate the provider logon validation process. Continue to Step 1c. Step 1c – Choose NPI or Provider ID “You can use this line to inquire about claim status, member eligibility, prior authorization status, check payments, and benefit limits through the Interactive Voice Response system or to speak to a customer service representative. Please press 1 to enter the National Provider Identifier or press 2 to enter the IHCP Provider Identifier.”  Press 1 to enter the NPI. “Please enter your National Provider Identifier, followed by the pound sign.” Enter the 10-digit NPI and then press . Continue to Step 2b. Step 2a – Enter NPI Library Reference Number: PROMOD00002 Published: January 21, 2020 Policies and procedures as of Novembe ...
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