SOPS (What's the deal with SOPs?)
Q. What part of Member’s Appeals SOP steps has to be completed in order to place your questions on the SME sharepoint, unless the question is about those fields?
Step 19. Refer to Completing ETS Fields and ETS Case Entry for additional information on which fields the RA must check, and how to verify their accuracy.
What SOP gives you the adjustment macro and what is the macro?
Requesting an Adjustment SOP – Step 6, The Adjustment Request for ETS macro (Ctrl + Alt + A) will assist with this step.
According to the Member Appeal Resolution Process - Clinical Research what is the clinical referral macro and what step is it in?
Step 12, Enter clinical referral comments in ETS, The Clinical Referral Comment Template for ETS macro (Alt + M) will assist with this step.
In the Letter Writing Process SOP under the section Clinical Uphold/Partial Overturn Letters, What states require the clinical reviewer’s name, credentials, and specialty to be included in the determination letter?
Arkansas, Kentucky, Nebraska, Arizona, Maine, New Hampshire, Colorado, Maryland, Rhode Island, Florida and, Massachusetts.
For the Fully Insured policies, which two SOG provide first level as Hearing?
SOG WI, DC (except for FEHB - Federal Employee Health Benefit)