Systems
This system is used to check eligibility for FLMMA and FLLTC members
What is Emdeon?
The current TAT for claims reconsiderations for FLMMA
What is 44 business days?
This is the name of the SOP where you can find the address for DSNP Chiropractor and Acupuncture
What is C&S Provider DSNP Chiropractic and Acupuncture?
A provider calls in from a pharmacy for the FLMMA to check appeal status.
This is your next step.
What is Check ETS for the appeal?
This is the newest system we have
PDAT
Follow these 2 steps after checking to see if a chemotherapy J code requires PA in Epal.
What is Click chemo DX code link and check to see if the DX code falls within any of the listed range?
This is the name of the SOP where you can find out what to do if there is a claim with a status of 99
What is Community & State- Provider locating a Claim and Claim Status SOP?
This is how this EDI number will look once entered into EDSS to view electronic image.
916182094141700
1820941417916
This is what will be taking place from Oct 17 through Nov 7.
What is Open enrollment?
The system used to look up a tracking number to get the FLN number
What is RMO/Denali?
These are the three SOP's to review regarding updates made due to plans moving to the integrated BH calls process
What is C&S Provider Integrated Behavioral Health SOP C&S Provider Integrated Behavioral Health, OPTUM Behavioral Health Network Management, and the Community & State Provider Quick Reference Guide?
The SOP that tells you what to do if a provider insists on receiving fee schedule information greater than 50 codes.
What is C&S Provider Network Management Routing Instructions SOP
A provider calls about a denied claim. The claim was submitted electronically and is denying for “validate for EPSDT referral code, condition code, or condition indicator”. The provider states that they put the code in box 24H but it is not showing in Macess. The provider insist that they can see the claim and the code is listed .
This is the name of the system to use in your next step.
What is EDSS?
This is the date range in which Participant Direction Option Service Model training will be held
UnitedHealthcare Community Plan periodically assesses our network to help ensure it meets the needs of our members. Starting in October 2018, UnitedHealthcare Community Plan of Florida is notifying approximately 10 physician practices throughout the state that their MMA (Medicaid) primary care panels will be closed to new membership assignment. This will not impact other lines of business, including Florida Healthy Kids (FHK/CHIP), Commercial (E&I), DSNP and Medicare (M&R).
This is the title of the 411 that was sent to tell us how to deal with this change
What is Florida Panel Closure Talking Points?
A provider calls and states that they called last month and a representative told them that the code didn't require auth. Now their claim has denied for auth req.
This SOP advised on what steps to take in this situation.
What is Provider Services- Misquoted Benefits SOP?
A member has a FL MMA with LTC HCBS plan. They would like to check to see if auth is req for T1019.
This is the name of the tab to use to check auth status.
What is LTC (includes FL MMA comprehensive HCBS)?
This is the contest that will be judged on OCT 31st for out Team.
What is the spooky cubicle decorating contest?
(anything about desk decorating and halloweem will count)
This is the date MA and FL Medicaid will move to the integrated BH call process
What is Nov. 1 2018?
This is the name of the SOP that give info about provider Peer-to-peer request.
What is Community & State Provider Appeals and Complaints Standard Operating Procedure (SOP)?
You receive a call from an INN provider for the FLMMA plan and they say:
“I want to know if J1726 requires Prior Auth and if it does I want to create it now.”
You confirm that it's not for Chemotherapy
This is the name of the link you need to click to create the authorization.
What is Injectable medications Administered in a home, Office, or Outpatient?