Agent Missed Punch 

FOR ANY MISSED PUNCH AND ITS SEND TO SABRINA

Please adjust agent's punch to reflect

Date:

Name:

clock in

Lunch:

Clock out:

ALT fax request 

Please verify these 3 pieces of info. Do step 4 if their code is not the same

1. ***Confirm there is a fax on file***

   1. If not, you will need to 2 step to add one

   2. If caller is unable to complete 2 step, do not send to alt fax. Offer to mail to address on file.

2. NPI

3. ADDRESS

4. That the ALT # is within the facility

5. 2step the NPI if the alt fax is not within the facility

CALL BACK FOR A ZELIS REP 

Request Call Back

Agent name:

TIN

Provider ID

Caller Name

Caller Title:

Email:

caller phone #

Best time to reach out to the provider :

Issue:

Do Not Contact

Tin:

Provider ID:

Customer name:

Phone:

EDI Support 

(Please provide the caller the edisupport@zelispayments.com email instead of submitting the template, the information below are items the caller needs to include in THEIR email)

TIN:

PID Examples:

Contact Name:

Contact number:

Authorized Decision Maker: Yes

Clearing House Enrolled:

Issue (Please be specific)

Enrollment Work Order 

Create a work order

Below is the process on how to create a work item.

1. Create Work Item

2. Department: Sales

3. Work Item Type: Retention Lead

*A template will not generate; Use Below Template*

• Contact Name:

• Contact Title:

• Contact Phone#:

• Provider Email Address: 

• Are they an authorized DM?

• Provider is requesting to enroll

• This is for the CARE/PE (Please choose a dept.)

Expedited Admin update 

THIS IS USED WHEN A ADMIN UPDATE WAS ALREADY DONE IN JIRA AND YOU SHOW A PPO IN THE NOTES (AFTER 10 WORKING DAYS)

Tin:

Provider ID:

Caller first and last name:

Caller Title:

Caller Number:

Product type:

User name:

User email:

When was the original PPO created?:

Jira Ticket #:

Call back information needed:

• Is the phone number on the NPI registry a valid number to call?

• If not, is there a secured website for this provider (please provide)?

• Is the number on the secure website a valid number to call?

• What time zone are they in?

• What are their hours of operation?

• Are there any times of day in which the ADM is unavailable? (ie. Lunch hours, scheduled meetings, etc.)

• Is there anything special about the phone tree/IVR that we need to know? (ie. extensions, sequence of numbers to get to the correct dept, etc.)

Please only fill this out when there as been previous admin update was submitted

Prior admin update should have expedited 10 working days before escalation.

FULL Payer List 

• Full Payer List Request

• TIN:

• Contact:

• E-mail:

• #: (edited) 

HOW TO CREATE A WORK ORDER / PUT IN THE WORK ORDER 

Create a work order

Below is the process on how to create a work item.

• Create Work Item

• Department: Sales

• Work Item Type: Retention Lead

*A template will not generate; Use Below Template*

Contact Name:

Contact Title:

Contact Phone#:

Provider Email: 

Are they an authorized DM?

Why are they requesting to Opt Out?

ISSUES WITH THE CLEARING HOUSE 

Refer caller to email (edisupport@zelispayments.com) and inform to email the following information:

EDI Support Email Guideline

• TIN:

•  Provider ID:

•  PID:

•  Contact Name:

•  Contact number:

•  Clearing House:

•  Issue (Please be specific) 

LOCKED ACCOUNTS, FORGOTTEN SECURITY QUESTIONS, AND RESET PASSWORDS (MUST BE THE ADMIN) 

Forgot Password/Security Question Issues Template

Callers First Name:

Callers Last Name:

Callers Title:

Are they an Admin user (Y/N):

Caller Email Address (You must verify that a user exists with this email address under the provider user tab):

Caller Phone Number:

TIN:

Provider ID (End of URL):

Callback Window:

Timezone:

Please choose the best one that applies (please delete what doesn't apply)(form will be sent back if one is not picked):

• A Previous Reset Password Link has Expired

• Create Password Link had Expired (Never created password)

• Forgot Answers to Security Questions

• If chosen, please ask this question: Is there any chance that another person in the office may have tried to use your username/password?

• If they say yes, please read the following statement to the caller: "We care about the security of your account therefore we ask you to prevent sharing your login credentials.  The admin can create a username for each individual who needs access.”

• Forgot Password and "Password recovery not available for this account"

• Forgot Username

• Password Recovery "Error Maximum number of attempts has been reached"

• If chosen, please ask this question: Is there any chance that another person in the office may have tried to use your username/password?

• If they say yes, please read the following statement to the caller: "We care about the security of your account therefore we ask you to prevent sharing your login credentials.  The admin can create a username for each individual who needs access.”

• Other

Payee hub number:

By submitting this form you are confirming there is an enabled user under the provider record with this email address.

**Timeframe for completion will be 72 business hours

Multiple Clearinghouse Enrollment Template 

Provider TIN:

Provider ID:

Provider Name:

Clearinghouse 1 (Default Clearinghouse, any new Payers added will

default to this Clearinghouse):

Payer(s) Included:

Payer(s) Excluded: 

Clearinghouse 2:

Payer(s) Included:

(At least one Payer must be included)

Payer(s) Excluded:

Clearinghouse 3: Payer(s) Included:

(At least one Payer must be included)

Payer(s) Excluded:

Example:

Clearinghouse 1 (Default): Availity

Payer(s) Included: Copy All Payers Except Cigna Here

Payer(s) Excluded: Cigna

Clearinghouse 2: Change Healthcare

Payer(s) Included: Cigna

Payer(s) Excluded: Copy All Payers Except Cigna Here

NOTE TEMPLATE 

1. Name:

2. Title:

3. Phone:

4. PID:

5. Reason for the call:

6. Resolution:

7. Outcome: Resolved

PARTIAL PAYER LIST 

• Partial List of payer:

• TIN:

• Contact:

• E-mail:

• #: (edited) 

Payer Exclusion 

Create a work order

Below is the process on how to create a work item.

• Create Work Item

• Department: Sales

• Work Item Type: Retention Lead

*A template will not generate; Use Below Template*

Payer Exclusion Request -

Product Type:

Name of Payer:

Tax Identification Number:

Provider ID:

Contact Name:

Contact #:

Reason for Exclusion:

Reporting Portal Issues Template 

Must be the Admin to proceed

•  Provider ID:

•  Contact Name:

•  Contact Email Address:

•  Username:

•  User Permissions:

•  Is User Admin: Y/N

•  Explain Portal Issue In Detail:

 Follow Troubleshooting Steps Below BEFORE submission

• Is User on Chrome Browser? Y/N

•  Is Chrome Updated? Y/N

•  Reboot Computer? Y/N

•  Has the User Checked Firewall/Antivirus? Y/N

•  If Unable To Download EOB's is USER in "Downloads” and NOT "Payments"? Y/N

 ***Last Option - refer cx to internal IT if applicable for help as our support options are limited to above.

 If ALL answers are YES, submit this template to your supervisor.

REQUEST TO CHANGE BANK INFORMATION 

• ON THE PORTAL

• PROVIDER SETTINGS

• CHOOSE VRA

• FOLLOW ALL THE STEP TO THE BANK PAGE

• THEN SIGN AND SUBMIT

SSO template 

(All information must be filled out)

TIN/Provider ID:

Caller Full Name:

Caller Title:

Caller Phone:

Caller Email: 

Is caller admin or is there an admin update request placed for caller? (If no, request cannot be completed):

2-Step Completed on Primary TIN? (If no, request cannot be completed):

Authorized Decision Maker on Secondary TIN(s)? (If no, request cannot be completed):

Primary TIN:

Primary Provider ID:

Secondary TIN(s):

Secondary Provider ID(s):

Is there an existing SSO for any of the TINs/Provider IDs listed above?

If yes, is the requester aware of this?

If yes, does the requester wish to remove the TIN(s) from the existing SSO and place it/them under the new SSO?

If yes, does this requester have the authority to do so?

Sup Escalation Template 

TIN:

Provider ID:

Payment ID:

Contact Name:

Contact #:

Callers Email:

Patient Name First and Last (if applicable):  

DOS (if applicable):

Payer (if applicable):

Is the payer apart of payer list:?

Issue:

What task was preform to fix the issue:

Two-Step Verification Template: 

• First and Last name of the person who validated the request:

• Title of the person who validated the request:

• Source URL:

• NPI Registry Update within 90 days (Yes/No):

• Telephone Number(s) dialed:

• First and Last name of the requester:

• Title of person of the requester:

• Email address:

• Decision maker status (Yes/No):

• Code:

• Brief summary:

Unable to locate payment 

Post in your team chat for assistance

Tax Identification Number:

Claim Number:

Date of Service:

Patient’s Full Name:

Claim Payer:

Policy Type (Medical, Dental or Worker’s Compensation):

Paid Amount:

Contact Name:

Contact Email (Required):

UPDATING THE NPI  

Before submitting please verify the NPI in the NPI registry making sure that the address and phone number, Name of the facility is matching what the caller provided.

NPI Update

TIN

Provider ID

NPI: new

Address:

Reason for the Update:

Did The Facility move:

Was a 2-step completed? (Y/N). (edited)

Verification Key template 

Full contact name (first and last name):

Contact Phone number (including extensions):

Email address:

TIN:

Provider ID:
PPO:

Verification Key received from letter: