Reversal of Denial
to complete a reversal of denial the overall status should be in?
what is Approved Status
i got assigned a case in denied status what does that mean for me as a UMAC?
what is start the denial process
i receive a case to create authorization what is first steps when member in focus in cgx?
what is verification in SRO as well as in scope or out of scope
what is the queue name to verify if UMAC has received task?
what is HSUM SNF Tasking
where does a web ivr originate from?
what is Availity
the name of the letter to be used is called
xMedicare_Reopen_Reversal of Integrated Denial Notice (IDN)_E
i start the denial letter and i need to send to and copy to who?
what is send to member and copy to Facility
you pulled a Member in focus and verified that member has a MES policy
what is do not create auth
the reason you make an outbound call to facility is why?
what is to verify if facility received a NOMNC
we update the provider information in CGX Details. what is the order it should be in
what is requesting SNF Facility, Treating Attending Doctor, and Facility SNF FAcility
do you send to Attending Physician?
what is no we send to Member and Facility
i am updating the Dynamic Fields and jump to the merge fields what will i need to update?
What is nothing should Auto Populate
in the provider fields we input which providers where?
what is SNF Facility in requesting and facility provider field and Attending in the treating provider field
NOMNC was received and we have to state the denial disclaimer is this True?
What is False, we do not have to state a disclaimer.
fax attached and it is the auth request only what is your next action due
what is Request CLinical 2
what are the Disclaimers you need to input when faxing to Facility
What is Provider and Grijalva Disclaimers
i have a case that is day 13 do i need to send any letters through Veritas
what is no go through fulfillment
the difference between SNF Admit Post hospital vs SNF Admit Direct
What is SNF Admit Post Hospital is post discharge from acute facility and SNF Admit Direct is admission from home.
if a facility received a NOMNC what do we do for Task
send back to nurse and in comments state NOMNC Received and faxed; Name of facility representative.
with web ivrs we check member central Authorizations why?
what is to verify if auth has overlapping dates or possible duplicate
when sending through fulfillment what is the letter type chosen
What is Reversal of Denial
when i am sending the letter through fulfillment it automatically wants to send to member and facility
what is incorrect only send to member
Member admitted to SNF Facility on 9/28/2024 and this request type is chosen while member has not been discharged
What is Request Type Concurrent
if a facility does not receive the NOMNC what is the subject line we input
what is NOMNC Not Received
if provider attaches clinical thru Availity you fax back to provider using which option in faxing thru CGX
what is we would not fax anything to provider..