The name of the plan that doesn't require authorization for PT (physical therapy) or OT (occupational therapy)
What is PCN?
100
Reason member services would call a provider to get an override
What is when a provider's panel is full?
100
Amount of time before an appointment that members should notify MTM that they need a ride
What is 3 business days?
100
Provider type that can prescribe medications
What is a psychiatrist?
200
Provider has 60 days to submit from the date of the denial
What is the time frame in which a provider can submit an appeal once something is denied?
200
For adults PT, OT and ST all require authorization for evaluations except for
What is pregnant women?
200
Number of days that a newborn's PCP can be backdated
What is 60 days?
200
This is allowed only when immediately following a covered appointment
What is trip to the pharmacy?
200
Non-covered level of care for BH/MH/SA
What is residential?
300
Parent/guardian of a minor member, or POA (power of attorney) for the member
What is someone who can file an appeal or grievance on behalf of a member?
300
Adults are covered every ___ months for vision exam and ____ months for lenses and frames
What is 24 and 24?
300
Time when you can back date a PCP change to the 1st of the month
What is requests received the 1st through the 14th of the month?
300
The following ME Codes: 02, 08, 52, 55, 57, 59, 64, 65, 73, 74, 75, 80, 82, 89
What is not eligible for transportation?
300
Based on _____ the MH would be managed by ABH of MO or MOHealthNet
What is the ME code?
400
No time limit for filing
What is the timeframe a member has to submit a grievance?
400
As of 02/01/17, this item no longer requires an authorization.
What is an electric breast pump?
400
The instance when a member under the age of 18 can request a PCP change for herself
What is when a member is pregnant?
400
The amount of time after an appointment a member has to submit a mileage reimbursement form
What is 60 days?
400
Testing that a psychologist can perform
What is psychological and neuropsychological?
500
Michael Knight at knightm2@aetna.com, La Shunta Crain at lrcrain@aetna.com, Lamonica Porter at lamoore@aetna.com , and Donna Boyle at dmboyle1@aetna.com.
What is the group that you would email for an expedited appeal?
500
This indicates that some members ages 18-25 retain the same dental and vision benefits as a member under the age of 21.
What is ME Code 38?
500
This is what you would look up in the provider directory when a member requests an ENT
What is an Otolaryngologist?
500
Current rate per mile for mileage reimbursement
What is 30 cents?
500
Non-covered service by ABH of MO but can be referred to MOHealthNet (FFS) for benefit and referrals