MIOD/CD
Name the SOP to submit / educate member on member-initiated organization determination (MIOD) requests.
Member Initiated Organization Determinations - Index
The SOP to help with documenting grievances.
System Documentation - Appeals, Grievances, Coverage Determinations and Organization Determinations
System used to locate authorization request that have been submitted by the member or a provider.
What is ICUE/HSR
How many Navigators are on Holly's Angels?
17
Luke Skywalker's father.
Who is Anakin Skywalker, aka Darth Vader.
Determination handled within 72 hours from the time of the call.
Standard Coverage Determinations Turnaround Time for PA and B vs D.
Grievances are resolved ______ ( ____ ); any follow up is done by ____.
You (the Advocate receiving the complaint)
72 Hours
What is the turnaround time for expedited appeals. (Expedited Appeals - After receipt of request)
Name our EEX Champions.
Amber and Brittany
Touch
Advocates should not direct members to their provider or call the member's provider to have them submit the ____ ____ on the member's behalf.
Coverage Determination
The tab for documenting Multiple intents on a single call.
What is the Multiple Issues = Multiple Intents tab.
The type of appeal can never be expedited.
Post-Service Appeals
How many dogs does Candace have.
5
What is Kits
Organization Determination requests submitted too far in advance will be cancelled, and the member will be advised to submit the request closer to their date of service. (what is the time frame)
(typically, no greater than 2 weeks)
A complaint regarding the process for coverage determinations / reimbursements / disputes will be reported has which Part of Medicare grievance?
Part D Grievance. Hint was "coverage determinations."
60 Calendar Days
Medical Claim Appeal Review (Post Service).
Maggie's husband
Who is Luis Ursua?
A chef's ___ has 100 pleats
This request is only used from October 15 – December 31 for requests prior to the 1/1 effective date.
Coverage Determination (CD) in Advance
Complete and accurate documentation is vital to ____ prevention.
CTM prevention.
The appeal must be filed with the QIO no later than 12:00 p.m. of the day following the receipt of the Notice of Medicare Non-Coverage (NOMNC), or by 12:00 p.m. the day before the coverage ends.
What is the deadline to file a Fast Track Appeal?
The state where Holly and Candace are from.
Minnesota
This word Japanese is the act of eating when you're not hungry because your mouth is lonely.
What is kuchi zamishi