A request for a service, procedure or medication that is not a routinely covered benefit
What is a PAR - Prior Authorization Request?
100
For this particular LOB, benefits "stop at the bathroom door".
What is Medicare?
100
Considered the 'youngest' looking grandma.
Who is Amy?
100
Reviews to approve continued treatments, such as inpatient hospitalization, home care, rehabilitation, DME, long-term care.
What is a concurrent or continued stay review?
100
A long standing rivalry amonst these two staff collegiate alma maters - Tigers versus Birds.
What is Karen and Jan?
200
When procedures, services and/or an admission to, or continued stay in, the facility cannot be justified as medically necessary
What is a denial?
200
A free benefit to those with Medicaid and helps patients get to/from appointments.
What is LogistiCare/transportation?
200
Recently had her 6th toe removed.
Who is Nettie?
200
A certification that shows a case manager has expertise in case management principles and practices.
What is a CCM - Certified Case Manager?
200
This staff enjoyes swinging high from bar to bar.
Who is Deb?
300
Arranging the transfer of a member from an outside hospital to their medical home for continued care
What is repatriation?
300
A free benefit for those who have complex medical needs and require a variety of resources.
What is Complex Case Management?
300
Ensuring that the needs of patients and their familes are met and place their interests above all others.
What is advocacy?
300
A Bronco diehard! She displays her pride proudly and has had season tickets for XX years.
Who is Sharon?
400
Examples include hospital bed, oxygen, walker, tub chair or commode
What is DME - durable medical equipment?
400
The only department where all the staff names begin with "E".
Who is Care Support?
400
Working together, with patients/families and/or providers, to formulate a plan to meet the desired goals. One of the primary characteristics of case management.
What is collaboration or communication?
500
Forms that document a patients decision about the type of medical care they would want to receive if they were unable to communicate those wishes
What is Advance Care Directives?
500
The designation certain DH community based clinics recently received with identifies case management services as needed and necessary component to managing health.
What is Patient Centered Medical Home?
500
What work? This staff will soon enjoy the rewards of not having to get up and go to the office everyday!