Triage and Contacts
All CM referrals must be screened within this timeframe after receipt to the NRECA Department Home Page.
What is 1 business day?
The database used to search NRECA benefit plans.
What is HPDB (Health Plan Data Base)?
Every oncology member must receive education about this benefit.
What are Cancer Center of Excellence (COE) benefits?
The minimum distance a COE provider must be from the member's home for TML eligibility.
What is more than 50 miles?
These cannot be sent to NRECA members.
What are Compassion Cards?
Total business days allowed from referral screening to CM outreach to the member.
What is 3 business days?
The term entered in the Search Company field when searching for most NRECA plans.
What is Master?
Two cancer centers that may require special contract review.
What are Huntsman Cancer Institute and Roswell Park Cancer Institute?
Members must meet this participation requirement to qualify for TML.
What is participating in Case Management?
The Disease Management vendor used by NRECA.
What is WebMD?
The organization that takes all member calls for benefits and claims questions.
What is CBA?
Two Aerial fields used to determine the specific NRECA group in HPDB.
What are the Benefit Plan Number and Group ID?
Failure to complete the COE contract step before services begin results in this.
What is the contract becoming null and void and claims being paid OON?
Members should retain these for reimbursement requests.
What are original receipts?
The specialty pharmacy benefit manager for NRECA.
What is CVS Caremark?
The phone number members call for benefits or claims inquiries.
What is 1-866-673-2299? or What is Customer Service for NRECA?
The correct contact when questions arise about benefit coverage not outlined in HPDB.
What is CBA nurse contact.
If a provider is not a COE, the CM should educate the member about these.
What are nearby Optum Cancer Centers of Excellence?
The lifetime maximum TML benefit for oncology diagnoses.
What is $5,000?
There is no bariatric benefit unless members use this type of facility.
What is a Bariatric Center of Excellence (COE)?
Before contacting a CBA nurse directly, CMs should first check with these individuals.
Who are the Manager, SME, Senior CM/TL, or dedicated NRECA CM?
The member must be receiving active treatment to receive this benefit.
What is TML?
A COE Notification Form must be submitted when a member uses a COE facility, regardless of this status.
What is INN or OON network status?
Notification forms must still be submitted even if the member is not eligible for this benefit.
What are TML benefits?
Chemotherapy and radiation treatment require this amount of prior authorization.
What is none (no prior authorization required)?