If you have doubts about what type of scenarios you can use for each disposition, please follow the list below:
| Level 1 -Mandatory | |
| Inbounds & Outbounds | Description |
| Adjustment Request – RD Approval | Approved Courtesy exceptions . Already noted in the memos. (Payment processed via the payment link.) For Panam use only. |
| Adjustment Request – ZBAL | ZBAL adjustments and patient calls back |
| Audit Test | Quality testing calls |
| Call Authorization Failure | Unable to Verify HIPAA |
| Call Rejected | The patient declined or didn’t answer |
| Compassionate Care – Application processed | The patient was pre-approved, and an application submitted |
| Compassionate Care – General (no application processed) | Pre-qualification was done, and instructed patient how to apply |
| Demographics Update (not insurance) | Updated the patient’s address, phone, and email |
| General Inquiry – Patient | Non-billing related calls. Can be used as well when the patient is given information on statement inquiries and payment options (not related to the insurance claim status); however, patient did not process payment and needed more time to consider. |
| Insurance – Appeals | An insurance company or patient calling about appeals |
| Insurance – Claim Resubmit | An insurance company or patient needing a claim to be resubmitted |
| Insurance – Claim Status | An insurance company or patient calling about the status of a claim, EOB explanation, etc |
| Insurance – Coding | An insurance company or patient calling asking for codes needed to process a claim |
| Insurance – General Inquiry | All inquiries from insurance companies (payors) |
| Insurance – Medical Records | Needs medical records |
| Insurance – Stop Claim | Hauling a claim |
| Insurance – Update/Changes | Insurance agent, patient, or authorized user calling to update Insurance information |
| Insurance – Self-Pay to INS Bill | To be used when a patient decides to switch from self-pay to billing their insurance instead. |
| Itemized Statements | Patient requesting itemized statements or receipts |
| Payment – Full Payment | statement balance paid in full |
| Payment – Link | Full payments or anything that is not a courtesy exception. Use this when the link was sent but the caller will pay later. |
| Payment – Missing | The patient called after a payment has been made and is still receiving statements we are requesting their proof of payment or the patient already made their payment and it’s posted in AMD |
| Payment – Partial | Walk down payments including Compassionate Care or other honored rates *Excluding courtesy exceptions* |
| Payment – Plan | The patient opted in for a payment plan. The billing rep guided the patient in setting up the payment plan. |
| Payment – Plan Canceled | Payment plan cancelled |
| Payment – Synergen Issue | Payment link issues |
| Payment – U-Contact Issue | This applies if the call dropped or if the patient never returned from the IVR system during the payment process. |
| Pending Synergen | Action pending Synergen, unable to provide resolution at this time |
| PTP – Case closed to insurance | The prompt pay offer has expired and the claim will be sent to the insurance |
| Refund request | The patient requested a refund and submitted |
| Req form request | The patient is requesting a copy of their req form – escalated to CSS |
| Test Status Email Provided | Non-billing related call – Managing Non-Billing Calls |
| Transfer – Advanced Pay | The patient is transferred to the advance pay team |
| Transfer – AMCA | The call was transferred to the offshore team |
| Transfer – AMCA CompCare | Compassionate Care calls transferred to the Natera Onshore Team |
| Transfer – Billing | The call was transferred to the Billing team |
| Transfer – CFS | The call was transferred to the CFS (sales rep) line |
| Transfer – Natera Clinics | The call was transferred to the clinic’s line |
| Transfer – Natera Escalations | Escalations and Non-Courtesy Exceptions |
| Transfer – Prior Authorization | PA-related calls were transferred to the PA team |
| Transfer – PTP/PTE | The call was transferred to the PTP/PTE team |
| Transfer – Resolutions | The call was escalated to the resolutions team |
| Transfer – Signatera | The call was transferred to the billing Signatera team |
| Transfer – Spectrum | The call was transferred to the billing Spectrum team |
| Transfer – Supervisor | The call was escalated to a CSS (NOT resolutions team) |
| Transfer – Courtesy Exception | Panam billing agent transferred to the Natera_Escalation campaign |
| Transfer – NCS | Panam billing agent transferred to Natera NCS campaign *Do not use* |
| Courtesy Exception – Manager Escalation | Natera agents transferring to leadership – outside of walk-down parameters (To be used by Natera only) |
| Courtesy Exception – Successful | Natera agent was able to provide resolution according to walk-down parameters (To be used by Natera only) |
| Unable to complete call – Agent disconnected | Agent disconnected call due to technical issues or unprofessionalism |
| Unable to complete call – Patient ended the call | The patient disconnected the call |
| Voicemail left | Outbound calls – left a voicemail |
Last update by: Claudia Fuentes (September 23, 2024)