UM Note Types
This note is used for communication between UM and Case Management regarding a shared case.
What is Co-Management
A NOMNC can be issued until any day between what hours
What is any day between 8:00 AM and 5:00 PM in the provider’s time zone.
Every case that meets DRG Readmission Review criteria must be sent to this person.
Who is the Medical Director?
IV fluids at this rate or higher constitute a clinical intervention.
What is 70 cc/hr or greater?
The CMS guideline used for SNF reviews.
What is Medicare Benefit Policy Manual, Chapter 8, Section 30?
Additional clinical is received after a medical necessity denial and a reconsideration review is needed.
What is Appended Reconsideration Review?
The QIO contact for a Kentucky facility is this
What is Acentra Health
Both the index admission and current admission must occur at facilities sharing this identifier relationship.
What is the same PIN/TIN?
A case should be referred to the Medical Director when requested days are missing this
What are clinical interventions?
Patients generally need this many hours of rehab daily to meet clinician approval criteria.
What is 3 hours per day?
This note is used to document discharge planning activities when no determination is being rendered.
What is Discharge Planning?
Tasking P2P that will be expired over the weekend get tasked to whom.
What is Kelly Smith
If there is no clinical information available for the initial or subsequent review, the UMNC should do this instead of sending the case to the MD.
What is follow the No Clinical process?
If no inpatient order and no clinical information are received by the deadline, this type of denial is issued
What is a Procedural Denial (Administrative Denial)?
Only this role can deny a medical necessity authorization request.
Who is the Medical Director?
This note is used when a case is auto-approved through automation and the UMNC documents the review without a clinical necessity review.
What is Admission Criteria?
The number of request for clinical for an acute case is many
What is 2
This claim payment instruction is entered for linked DRG readmissions.
What is DRG Readmission?
UMNCs may independently approve up to this many days when clinical interventions are present.
What is 10 days?
The QIO decision is a technical overturn related to lack of information, what do you do
What is
A UMNC reviewed an EMR, found insufficient clinical information to make a determination, did not contact the facility, and plans to check the EMR again later.
What is Review Initiated – CCR?
A member had a stay of less than 24 hours and a confirmed discharge. What criteria can the UMNC approve the case
What is
A member discharging and returning before midnight on the same day qualifies as this type of readmission
What is a same-day readmission?
This letter is used when a Medicare long length-of-stay denial is issued
What is the Acute IP Medicare Long Length of Stay Letter?
A member has 2 requests for a par SNF facility and is planning on going to facility B, What should you do with facility A
What is cancel the request for facility A