How to answer & reply for inpatient GL-related queries forwarded by HealthMetrics? (for panel inpatient hospitals)

REPLYING & ANSWERING QUERIES

1. Queries which require clarification by HealthMetrics will be sent to panel hospital personnel via HealthMetrics portal.  
2. Note that queries can be sent by HealthMetrics at any point of time and can be replied within the portal under the Initial Guarantee Letters widget, the Current Admissions widget and finally the Final Guarantee Letters widget for further clarification prior to the next action of the inpatient GL request initiated by the panel inpatient specialist. 
3. Query raised by HealthMetrics will be displayed in the HealthMetrics portal and all queries received will be notified via email and highlighted in the Dashboard in HealthMetrics portal.
   
4. Note that all queries must be reverted & answered via the HealthMetrics Portal – through (1) Dashboard or (2) Admission Timeline.

THERE ARE 2 TYPES OF QUERIES:

1. Medical Query [To be completed by attending doctor(s)]
2. General Query (To be completed by admission staff)
   All submitted/reverted queries will be recorded in the Admission Timeline under Queries tab.
   Hospital personnel can view the submitted/reverted queries (if any) at any point of time.

REPLYING QUERIES FROM "DASHBOARD"

1. When there is a query sent to hospital - hospital will be notified via email and the patient’s/member’s profile will be highlighted in the Dashboard as shown.
2. Hospital personnel can filter by clicking on Queries to filter out other requests.
3. Click on Reply Query to view the type of queries.
   • For Medical Query – directed to attending doctor(s). Click Download Medical Query Form to pass to attending doctor(s) to complete accordingly. **Note: Personnel can also click on any documents under “Other attachments” to view what was highlighted**
   • For General Query – directed to other hospital personnel/staff such as missing forms or signature on form or member/patient information unclear.
4. Personnel to upload all completed forms then click on Submit reply.
5. Once submitted - HealthMetrics Claims Assessor will proceed accordingly with the request sent in.

REPLYING QUERIES FROM "ADMISSION TIMELINE"

1. At admission timeline - click > Reply to view the type of queries.
2. Follow Step 2 to Step 4 mentioned above.