Types of intake
When initiating a new Out-Patient request. What are the 2 of the main pieces of information that we need to collect from the provider? And, if the provider does not have this what do we do...
1. The Service Start & End Date
If the provider does not have, we confirm if todays date (for the start), and if the default date (90 days) that auto populates is ok.
What is the system that is used to initiate a medical PA request for the following states: TX, LA, and FL?
ICUE
We as C&S advocates, build PA requests for BH.
FALSE
This template should be used with which type of Intake request?
Request received by Phone
Contact Name:
Where caller is calling from:
Contact Phone:
Contact Fax:
Medical Record Number:
Clinical Contact/UM Nurse:
Is this case related to? MVA or Work related injury
Service Reference Number (SRN) given to?
Pended for Clinical Review? Yes
Tasked to:
IC Name/Title: , Intake Coordinator
Pending for Clinical Review – Acute Inpatient
Which tools and resources will be useful in assisting with the build of a PA?
We should only notate CSP FACETS if the provider calls in to obtain the status of a PA?
False: We notate both CSP FACETS and IQUE.
Which type of PA provides a decision that can be rendered/completed by us while on the call with the provider if all guidelines have been met?
Administrative Approval
EPAL is used to confirm if PA is needed for which LOB, is it our MEDICARE or MEDICAID LOB, or BOTH?
MEDICAID
We build all cases except for?
Transplant cases
What information should we obtain and document from our caller when creating a NICU request?
Baby’s Medical Records number:
Baby’s Date of Birth:
Mother’s Member ID:
Mother’s First and Last Name:
Facility Name:
Facility Address (street, city, state, and zip code):
Facility TIN or NPI:
Attending Physician’s Name:
Attending Physician’s TIN or NPI:
Where are all of the Intake Job Aides housed?
In our memory
Knowledge Central
Intake tool
411 Resopitory
Intake Tool
Can a INN provider can Initiate a PA for an OON provider?
True
For a DME PA, for our Medicaid LOB what are the modifiers need to be included in a request for a new or rental item.
For Medicaid PA is needed if the cost of the item is greater than what amount for an INN provider.
NU is the modifier used for "New" items
RR is the modifier used for "Rental" items
If the cost is greater than 500 for an INN provider PA is needed.