Referrals
Three types of pharmacy referrals are: ____
What are behind the scenes, direct to consumer and discharge follow up
Review of an extension of previously approved/certified or ongoing course of treatment is ____.
What is a concurrent review
The success stories template is housed on _____ site for CM reference.
What is sharepoint
Requests of one week or longer require this ____ weeks notice.
What is 2 weeks
A member should not be referred to the medical director unless they are ____.
What is engaged
Timeframe (calendar days) for prospective non urgent reviews is ____.
What is 15 calendar days
The area of the success stories that most directly impacts the group is noted as the _____.
What is financial impact
No more than how ___ hours can be flexed within the same week with your managers approval
What is 4 hours
The outcome of the social work referrals are saved to _____ location for the CM review.
What is Aerial program attachments
Individual that makes all adverse determinations and completes peer to peer reviews is ____.
What is medical director
This group does not participate in success stories
Who is TRH
The amount of time employees should attempt to call in to their manager for unplanned PTO prior to the scheduled start time is ____.
What is 1 hour
The newest criteria for referring member’s to MD as discussed on Sept large team meeting is ____.
What is heart failure
Review that is done to determine the level of coverage available for specific services within the plan but does not guarantee benefits is _____.
What is pre determination
You only have ___ time to complete the Success story after obtaining verbal permission from the member.
What is 14 days
When notification of PTO approval has been received, the program ____ should be immediately updated.
What is MHD
The Aerial note type utilized by CM when referring to social work is ____.
What is Social work referral
Timeframe for prospective urgent reviews (utilized when member’s life or immediate health is in jeopardy, impacting the ability to regain maximum function or based on physician’s opinion) is ____.
What is 72 hours
The Task Reason ______ with outcome of _________will be completed once CM has completed and saved success story.
What is CM Success Story Non-Consented/Consented with Outcome of: CM Activity Completed
The number of hours you can carry over to the next calendar year in PTO is _______.
What is 40 hours