WGS
This key will take you back one screen (except in Corp. Menu)
What is F3
Click this to view the Provider's Medicaid contract or contracts.
What is the View RMB button
Case Summary
These are bolded
What are recovery milestones
This type of guideline have BLOS
What are GRG's
You change your WGS password in this place.
My IT Profile (Remember- 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
Which guidelines (product) have Extended Stay & Common Complications?
What are ISC's
What is a max number of ISC's you'd want to use based on the main dx drivers of the mbr. (good rule of thumb)
2
Where do you locate PMG/PCP ID.
From the CI screen in active contract, press F11. Look for the 3 Character code and if group is Cap/FFS.
To accurately identify the correct PMG group in SPS; what are the two fields to select and enter ?
What is the select Grouping ID, then enter PMG Code plus 000 or 001.
This time zone is used for TAT
Eastern
Name the 4 variances
Positive, Medically necessary, Potentially avoidable, Does not apply
What are the products we license?
What is ISC, GRG, RFC, CCG, BHG.
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 2 ways to enter Corp. Menu (check CPT codes, pricing & auth indicators.)
From KK screen hit YY, or F11 twice from CI screen
CA- 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 Anthem's preferred guidelines.
What are ISC's
This guideline uses Stages during the hospital course
GRG's