WGS
This key will take you back one screen (except in Corp. Menu)
What is F3
What do you click to view the provider Medicaid contract/contracts.
What is View RMB
Case Summary
This is bolded
What is a recovery milestone
This type of guideline has BLOS
GRG's
You change your WGS password in this place.
My IT Profile (change WGS password when you change your UID password.)
You search for a provider using this
first and last name
When sending a case to the PCR- what is the decision and reason?
Pend / Peer Clinical Review
Extended Stay and Common Complications are found in which type of guidelines
ISC's
What is the maximum number of ISC's you can use based on the main diagnosis drivers of the member
2
You use this area when verifying PMG Grouping ID Code.
PA, then Select HMO/PPO, press enter. Enter 3 Character PMG code plus 3 zeros or 2 zeros plus 1 in PMG area. press enter, on entry select the SPS Grouping ID listed.
What are the two most important factors to accurately identify the correct PMG group and risk type?
What is PMG group name and Code
This time zone is used for TAT
Eastern
Name the 4 variances
Positive, Medically necessary, Potentially avoidable, Does not apply
What was eliminated by OMPTA in the 29th edition of MCG
What are Anthem Customized Guidelines
This key is used to locate an active contract in the CI screen.
F5
Only California selects this button to view the contract options
what is non-west
Where would you look for medical records in ACMP
Fax tab, Fax log, or Notes tab, Case summary orange notification
0-17 yrs old
What is the age range for pediatric guidelines
Why would you use Extended Stay or Common Complications?
when there are variances or other health issues during the course of care and additional days / guidelines may be needed
What are the 2 ways to enter the Corp. menu (check CPT codes, pricing and auth indicators.)
From KK screen hit YY, or F11 twice from CI screen
What is one way to filter your results when looking up a contract for a provider or facility?
Line of Business Filter- Medicaid
OR
Network ID- CA-HMO Medi-Cal Mainstream/ LA Care
Case Summary and Case Details/coverage
These are the preferred guidelines in Anthem.
ISC's
This guideline uses Stages during the hospital course
GRG's