Yale School of Medicine

YMG Administration

YMG Administration

Yale Medical Group
300 George Street, 6th Floor
PO Box 7309
New Haven, CT 06519-0309
Tel: (203) 785-4851
Fax: (203) 785-6975
ymg.info@yale.edu

Policies. Procedures, & Forms

Frequently-Used Forms

Form Name and Link

Last Revision Date

Master Schedule Maintenance 7/24/06
PFS Report Request Form 7/24/06
Patient Label Download Request 7/24/06
Referring Providers Add-Edit Request Form 7/24/06
Scheduling New Provider Request Form 7/24/06
Charge Correction Request 3/01/09

All Policies Procedures & Forms

Procedure Number Procedure Name and Link Last Revision Date Number Form or Exhibit Name and Link Last Revision Date
1000 Admin          
1100 Office Of Patient Advocacy - Patient Complaints 07/01/09 1100.FM.A A Record of Complaint Intake 07/01/09
1105 Administrative Support Services 07/01/07 na na  
1110 Emergency Telephone Plan 10/01/06 na Emergency Call Forward List 10/01/06
1205 Authorization of Expenditures 07/01/07 na na  
1401 Recruitment and Hiring 07/01/07 na na  
1405 Employee Status Changes 07/01/07 na na  
1410 Performance Appraisal Methodology 05/01/04 1410.FM.A Employee Performance Appraisal Worksheet 01/01/08
1415 Goal Planning and Development 07/01/04 1415.FM.A Goal Planning and Development Worksheet 7/1/04
1605 Project Information Tracking 07/01/07 na YMG Project Log 07/01/07
1610 Records Retention & Archival 07/01/07 na na  
1805 Managed Care Contracting 07/01/07 1805.FM.A Managed Care Negotiations Worksheet 7/1/00
1810 Fee Schedule Reconciliation 09/01/05 1810.FM.A New Fee Schedule Task List 07/01/07
1810.FM.B Contract Fee Terms Checklist 9/1/05
1910 Prevention of Fraud, Waste and Abuse 08/16/07      
2000 Registration
2105 Registration Training 07/01/07 2105.EX.A IDX Registration Add/Edit Training Manual 10/7/02
2115 Batching and Assignment of Work 07/01/07 2115.FM.A Batch Log Workbook 7/12/04
2120 Telephone Call Management 07/01/07 2120.EX.A Central Registration Telephone Training Script 9/1/04
2205 Registering Patients 07/01/07 2205.EX.A Non-IDX Scheduled Departments and Clinics 7/1/00
2215 Registration System Interface 07/01/07 2215.EX.A IDX – SDK Registration Interface Process Flows 5/14/04
2260 Registration / Review All 09/01/04 2260.EX.A Data Elements Required for Reg Rev All - Yes 7/1/00
2310 Lifetime Insurance Agreement (LTIA) 07/01/07 2310.FM.A First LTIA Request Letter - Patient 7/1/00
2310.FM.B First LTIA Request Letter - Guarantor 7/1/00
2310.FM.C Second LTIA Request Letter - Patient 7/1/00
2310.FM.D Second LTIA Request Letter - Guarantor 7/1/00
2310.EX.A LTIA 7/1/00
2310.EX.B Frequently Asked Questions 9/1/04
2315 Notice of Privacy Practices (NOPP) 07/01/07 2315.FM.A Acknowledgement of Receipt of Notice of Privacy Practices 6/2/06
2315.EX.A Notice of Privacy Practices 6/2/06
2330 FSC Changes 07/01/07 2330.FM.A FSC Change Worksheet 7/9/04
2345 Registration - Temple & Guilford Medical Centers 07/01/07 na na  
3000 Cash Posting
3200 Cash Batching 07/21/04 na na  
3300 Cash Posting 07/01/07 na na  
3400 Credit Balance Processing 08/01/09 3400.FM.A Request for Refund 4/1/05
3400.FM.B Transfer Request 4/1/05
3400.FM.C Refund Batch Control 4/1/05
3405 Credit Balance Processing Training 07/01/07 na na  
4000 Accounts Receivable
4025 No Response from Insurance Carrier 07/01/07 na na  
4045 Waiver of Co-insurance 07/25/05 na na  
4060 Insurance Claim Edits 07/01/07 na na  
5000 Collections
5001 Budget Plan 01/01/09 5001.FM.A Budget Plan Criteria 10/1/98
5001.EX.A Payment Arrangement Letter 10/1/98
5001.EX.B Broken Payment Arrangement Letter 10/1/98
5005 Internal Collections 01/01/08 5005.EX.A Final Demand Letter 10/1/98
5005.EX.B Collection Letter #1 10/1/98
5005.EX.C Collection Letter #2 10/1/98
5005.EX.D Collection Letter #3 10/1/98
5010 External Collections 07/01/07 na na  
5020 Bad Address 07/01/07 5020.FM.A Bad Address Worksheet 10/1/98
5025 Deceased Patient Accounts 07/01/07 5025.FM.A Deceased Patient Log 10/1/98
5030 Request for Account Hold 07/01/07 5030.FM.A Cancellation or Modification of Patient Charges Form 9/1/00
5035 Financial Hardship 02/01/09 5035.FM.A Financial Statement 7/1/04
5035.FM.B Financial Statement Cover Letter 7/1/04
5035.FM.C Request for Write Off Approval Worksheet 7/1/04
5035.FM.D Financial Hardship Checklist 7/1/06
5035.EX.A Federal Poverty Guidelines, 250%, based on Family Size 2/01/09
6000 Patient Services
6010 Telephone Inquiries 07/01/07 na na  
6020 Email Inquiries 07/01/07 na na  
6030 Written Inquiries 07/01/07 na na  
6050 Complaints - Billing Compliance 07/01/07 na na  
7000 Reimbursement
7001 Encounter Form Review 07/01/08 7001.FM.A YMG Annual Encounter Form Review Summary 07/01/07
7001.FM.B YMG Encounter Form Review Report 07/01/08
7005 International Patients 07/01/04 7005.FM.A Estimated Case Rate Questionnaire 9/1/00
7005.FM.B Financial Agreement 9/1/00
7005.FM.C Financial Statement 9/1/00
7015 Referral for Specialist Services 07/01/07 7015.EX.A Managed Care Referral Guide 02/01/09
7020 Uniform Fee Schedule 07/01/00 na na  
7035 Profile Variance 07/01/06 7035.EX.A Profile Variance Department Exclusions 07/01/07
7035.FM.A Profile Variance Quality Assurance Worksheet 7/01/06
7035.EX.A Profile Variance Report Exclusions 2/13/06
7040 Insurance Claim Appeals 07/01/07 7040.FM.A Appeal Form - Cigna 4/28/04
7040.FM.B NGS Appeal Form -
Medicare		 8/01/08
7040.FM.C Appeal Form - United Healthcare 07/01/07
7040.EX.A Appeal Letter Modifier 22 4/28/04
7040.EX.B Appeal Letter Modifier 24 4/28/04
7040.EX.C Appeal Letter Modifier 25 4/28/04
7040.EX.D Appeal Letter Modifier 50 4/28/04
7040.EX.E Appeal Letter Modifier 57 4/28/04
7040.EX.F Appeal Letter Modifier 59 4/28/04
7040.EX.G Appeal Letter Bundling 4/28/04
7040.EX.H Appeal Letter Underpayment 4/28/04
7040.EX.I Appeal Letter Units 4/28/04
      7040.EX.J Appeal Action Codes 07/01/07
7045 Waiver of Liability (Non-Medicare) 09/01/06 7045.FM.A Patient Responsibility for Payment (Waiver) (SP-90) 5/1/04
7045.FM.B Patient Responsibility for Payment (Waiver) (SP-90) (Spanish) 2/1/05
7050 Advanced Beneficiary Notice for Medicare 09/01/08 7050.FM.A Advanced Beneficiary Notice (SP-91) 09/01/08
7050.FM.B Advanced Beneficiary Notice (SP-91) (Spanish) 03/01/09
7050.EX.A Medicare
Advanced Beneficiary
Notice Tips		 09/01/08
7050.FM.B Advanced Beneficiary Notice (SP-91) (Spanish) 2/1/05
7500 Solid Organ Pre-Transplant Evaluation Billing 12/01/08 7500.FM.A Notification of Patient Enrollment or Disenrollment in a Pre-Transplant Evaluation Case 09/01/08
7500.EX.B Solid Organ Pre-Transplant Evaluation Billing Scenarios 09/01/08
7500.EX.C Yale University Solid Organ Pre-Transplant Billing Summary for YNHH 2/1/05
8000 Quality Assurance
8001 Central Registration Quality Assurance 6/01/06 8001.FM.A Central Registration Phone Monitoring Wksht  
8001.FM.B Central Registration Audit Worksheet  
8005 Cash Posting Quality Assurance 6/01/06 8005.FM.A Cash Posting QA Data Log  
8005.FM.B Cash Posting Corrective Action  
8010 Insurance Follow-Up Quality Assurance 6/01/06 8010.FM.A Insurance Follow-Up QA Data Log  
8010.FM.B Insurance Follow-Up Corrective Action  
8015 Self Pay Collections Quality Assurance 6/01/06 8015.FM.A Self-Pay Collections Telephone Quality Assurance Worksheet 6/1/06
8015.EX.A Self-Pay Collections Performance Standards 6/1/06
8015.FM.B Self-Pay Collections Account Audit Worksheet 6/1/06
8020 Patient Services Quality Assurance 6/01/06 8020.EX.A Patient Services Performance Standards 6/1/06
8020.FM.A Patient Services Telephone QA Worksheet 6/1/06
8020.FM.B Patient Services Written Correspondence Quality Assurance Worksheet 6/1/06
8050 Credit Balance Audit 05/14/04 8050.FM.A Credit Balance Audit Worksheet 10/22/03
8060 Credentialing Quality Assurance 07/01/06 8060.FM.A Credentialing Quality Assurance Worksheet 07/01/06
8070 Solid Organ Pre-Transplant Evaluation Billing Audit 12/04/09 8070.EX.A Solid Organ Pre-Transplant Evaluation Billing Audit Results Memo 10/16/09
8070.FM.A Solid Organ Pre-Transplant Evaluation Billing Audit Worksheet 10/16/09
8070.FM.B Solid Organ Pre-Transplant Evaluation Billing Audit Corrective Actions 10/16/09
8080 Confidentiality Statement Audit 10/01/06 8080.FM.A Confidentiality Statement Audit Worksheet 10/01/06
8090 Medicaid Billing Audit 01/01/09 8090.FM.A Medicaid Billing Audit Worksheet 09/01/08
8090.FM.B Medicaid Billing Audit Corrective Action 07/01/06
8100 Clinical Research Studies Billing Audit 05/13/09 8100.EX.A Clinical Research Studies Billing Audit Results Memo 11/01/07
8100.FM.A Clinical Research Studies Billing Audit Worksheet 11/01/07
8100.FM.B Clinical Research Studies Billing Audit Corrective Actions 05/01/09
8200 Process Improvement 12/01/06 8200.FM.A Process Improvement Worksheet 12/01/06
9000 Information Systems and Training
9010 Common Billing System 07/01/07 na na  
9020 Security for IDX Access 07/01/07 9020.FM.A IDX Course Registration 5/20/02
9020.EX.A Scheduling Locations Request 11/1/06
9020.FM.B IDX Application Security Request 10/9/06
9020.FM.C Confidentiality of Medical Records 9/18/06
9020.FM.D IDX Login Waiver 11/5/03
9030 Social Security Number Access 12/01/08 na na  
9035 Security of Communications Containing a Social Security Number 6/01/09 na na  
9040 Training Program 07/01/07 na na  
10000 Clinical Business Operations
10005 Cash Collection in Clinic 07/01/07 10005.FM.A Daily Deposit Transmittal Form 6/01/09
10005.FM.B Triplicate Cash Receipt (Form # OPS-78)  
10605 Tracking Clinical Research Studies 08/01/08 10605.FM.A Request to Create a New or Re-Approved Clinical Study in GE/IDX 01/13/10
10605.FM.B Notification of Patient Enrollment, Termination or Completion in a Clinical Study in GE/IDX 9/11/08
11000 Clinical Research
11010 Tracking Clinical Research Studies Audit 10/27/08      
12000 Credentialing
12010 Credentialing 01/01/08 12010.EX.A YMG Credentialing Committee Members 1/1/09
12010.FM.A Nondiscriminatory Statement 2/9/04
12010.FM.B Confidentiality Form--Faculty 3/10/04
12010.FM.C Confidentiality Form--Staff 2/9/04
12010.FM.E YMG Cred/ReCred Application 9/16/04
12010.FM.F Credentialing File Checklist 1/1/06
12010.FM.G Monitoring Checklist 10/13/04
12020 Provisional Credentialing 1/25/05  
12030 Billing Data Entry for Newly Credentialed Providers 10/01/08