Intake

ICUE

100

Filling out this tool will help me build my case in the service information section of the short form.

CNS Auth Entry Grid

200

I need to do this type of search to review the history tab and see if any prior authorizations are already on file 

Member Search

300

This tab in ICUE tells me who the members case manager is

Care Details/Care Team

400

I need to check this tab to find out the outcome of the clinical review for medical necessity

Decisions Tab

500

I can look under this tab for a log of information pertaining to the case, including request for additional information, approvals, and denial information. 

Notes Tab

Inpatient

100

True or False. I can only backdate an inpatient case 93 days. 

False. We can backdate inpatient cases as long as the member is eligible during the DOS. 

200

Provider is calling today requesting a PA for an ER admit yesterday. What is my admit & discharge date? 

Admit - 06/07/22
Discharge - 06/09/22
Notification + 1 day

300

Inpatient services require that the member be ________. The in-hospital confinement last _____ hours or more. 

Admitted / 24 hours

400

This word in our service description means the patient is inpatient at this time, admitted through the er, (head in bed) 

Emergent

500

These types of codes are only going to be needed on Inpatient Surgery cases, not all IP cases

Procedure codes

Outpatient

100

Name 3 place of services that are considered OP

Home, Office/Clinic, In-Home Hospice, ASC, Free Standing Clinic

200

For our OP cases, its very important that we are verifying the provider's _______ to make sure they can request the case. 

Network Status

300

Once I select my service setting to Outpatient on the Communication Screen, and enter a start date, the end date automatically populates how far in the future? 

3 months out

400

This screen after my short form will allow me to enter in my units/frequency for my procedure codes

Complete Clean-Up Screen

500

Provider is requesting PT authorization starting on Monday. Can I backdate and create case? 

No. All therapy cases must be created for the same day of the request or a future date.

SSG

100

For this type of auth request, my actions required by staff tell me to warm transfer the caller to ICM BH Auth

Behavioral Health

200

Provider is requesting a Peer to Peer. What is that phone number I should provide? 

Phone: [phone]

300

When building an injectable case, what does the SSG list in actions required by staff for me to tell the provider? 

Requirement* To meet processing deadlines, request that Clinical information be faxed to the Specialty Injectables fax number at 877-234-0653.

400

For an INN provider requesting a PA for Outpatient Home Delivery or Birthing Center, is PA required? 

Outpatient Home Delivery or Birthing Center:
For INN Provider requests, Prior Authorization is not required. Direct the Provider to call the NASU phone number listed on the Contact Information line, upon delivery with the birth outcome.

500

What is my WQ for all inpatient, direct and emergent

CSAICE

Intake Sharepoint

100

This job aid will help me know if I can create case for a provider OON. 

Out of Network Request

200

I can use this job aid to determine if I can backdate a case. 

Late & Retroactive Requests

300

This job aid helps me build the case if the provider doesn't have a diagnosis or cpt codes. 

Request for Missing Information

400

This job aid tells me what changes, if any, I can make on an existing case

Authorization Updates or Changes

500

This job aid gives me the steps for case creation for prior authorizations for our medicaid members. 

Intake of Medicaid UM Requests