Dax 30203
True or False:
For members with age 18 and above with certain primary diagnosis, they are exempted from prior authorization requirements for specific physical medicine services.
Answer: False - Members aged 17 and younger with certain primary diagnoses are exempt from prior authorization requirements for the following physical medicine services.
- Physical therapy
- Occupational therapy
- Speech therapy
True or false:
When only the site-of-service requires review, preauthorization is STILL required when procedures are performed in an ambulatory surgery center, physician office, or emergency facility for urgent services.
FALSE,
preauthorization is NOT required when procedures.
True or false:
T/F: Retiree plans are required to follow PPACA recommendations. For grandfathered plans that follow PPACA preventive care, services rendered by excluded provider types are not covered.
ans: False
Multiple Choice:
As of what DATE did acupuncture, chiropractic and massage did no longer require authorization?
a) April 01, 2021
b) April 02, 2022
c) April 01, 2022
Answer: April 01, 2022
Which of the following site is NOT USED by our providers as it DOES NOT contain a complete list of procedures that require SOC review?
a. regence.com
b. availity.com
c. asuris.com
Answer: b. availity.com
For Grandfathered Plan Guidelines what GROUPS have the right to customize benefits.
a. Regence
b. ASO
c. Non-ASO
b. ASO
Fill in the Blanks:
When provider initiates an authorization, they must be registered on the
provider website under the specific Plan name (for example, Regence BlueShield), not Cambia.
Answer: eviCore
If a provider wants to submit their preauth request by fax,
________________ form is the form they need to include to provide attestation-based support documentation.
*Surgical Site of Service Additional Information form
Providers must _______________ be in the state in which services are provided and the services rendered must be medically necessary and within the scope of the provider's license.
ans. licensed state