Roles and Responsibilities
This role is responsible for letter generation.
What is a CP?
This is where you find the documentation templates
What is the Principles Document?
What tab is your work queue located?
What is the My Cases tab?
You would check to determine if a fax has been sent in this area.
What is the fax status queue?
This is also called a "never event".
What is a SRAE (Serious Reportable Adverse Event)?
This role is responsible for DME.
What is the CRC - PA role
When your name and credentials are added to the end of a note or entry made.
What is how do you document your signature in a clinical note?
What is the action of the capture outreach icon?
What is documenting phone/fax/emails/E-portal?
These are the reasons you would have only 1 Pega application opened.
What is protecting HIPPA information in Pega? What is preventing an error in documentation in Pega?
This guideline is used for accurate and consistent upgrading of Standard/Routine authorizations to Expedited/Urgent PA (prior authorization) requests.
What is Medical Exigency?
This role is responsible for the phone queue.
What is the CRP?
This is the only place to document patient health information on a fax.
What is the PHI box?
Where do you go to change your roles?
What is the icon with your initials?
This is the area where workflows are located.
What is the Systems training guides/Pega UM.
This is a review that occurs after a service has been completed.
What is a Retrospective Review?
This role conducts Peer to Peer Reviews.
What is the MD?
This is considered a legal document.
What is any documentation withing a client's records?
You can send messages in Pega with this.
What is the internal communications?
To improve the health and lives of our members by delivering high quality health care.
What is Molina's Mission statement?
This is a request for coverage of medical care or services that required a PA (prior authorization) and the services have already been received.
What is a Post Service Request?
This role is responsible for office visits.
What is the CRC PA?
This is the tool most frequently used to determine medical necessity for IP level of care.
What is MCG?
The route to MD check box is here.
What is page 2 of the CRC review?
What is: Integrity always, Absolute accountability, Supportive teamwork, Honest and open communications, Member and community focused?
Name 2 of the Quadruple Aim.
What is member satisfaction, provider satisfaction, lower care costs, improved health outcomes?