Research
What are the 2 ways Advocates can receive an NPR request?
Email, and phone
What is the TAT for an approval, pend, and denial?
NPR must be approved, pended or denied by the 2nd business day
What if you get routed a review that was an intake by another Advocate and was missing information that is needed?
Reach out to the contact person and/or the providers to gather more information. You can also try reaching out to the Advocate that started the NPR to potentially get more info from them.
What is the timeframe for talk therapy or med management availability?
Within 10 days.
Can be found in Documentation Behavioral health NPR's - Commercial Advocate clarification
If you could live anywhere, where would it be?
Answers vary
When is it appropriate to use a general code from Google?
After you've
1. Asked the member for codes
2. The provider (referring or servicing)
3. Check the member’s claims
Google as a last resort! This should NEVER be used first!
Name two examples of something that does not qualify for a nonpar review
Answers vary
What is the overall process for doing a review on a restricted SHCC member.
Has to be started with the care manager. If member is not on the line we need to reach out to them before initiating the review.
The decision must be given to the care manager and they will reach out to the member.
What do you do if a member was misquoted and is looking to get their visit covered?
Transfer to HBS to start an exception.
Who is considered 'Prank Sinatra' on New Girl?
Winston Bishop
Name 5 different types of super specialty SERVICES.
Answers vary and can be found in Documentation under Super Specialty Services - Advocate clarification
What is the pain management timeframe when trying to find INN options?
30 days
You are going on vacation in a few days and have a few reviews in follow up that will not be finished by then. What is the best thing to do?
Block time off in the calendar in Jiva ahead of time. However, if it is already assigned to you then reach out to your sup so they can further assist you.
What is one extra thing we want to try and get on BH reviews?
Servicing providers email.
What video or GIF makes you laugh every time?
Answers Vary
What are some helpful resources to use while doing research?
Answers may vary
You get a review for a patient to be seen at the University of Utah Motor neuron clinic. Will you be able to approve, pend, or deny with this information?
This is considered an automatic pend to HC - Info can be found in the "Pend Criteria" doc under the NPR folder in documentation.
What are some things that will not go in favor of time management when working on reviews?
Answers may vary
Can we start a review for dentists?
Only if it is for a Medicare member.
Or
A member needs assistance from a dental provider for a medical DX.
How many minutes does it take Light to travel from the Sun to Earth
8 minutes and 20 seconds
When should we be verifying a providers Tax ID?
When the OON provider has multiple addresses on file in Facets Provider Search.
Answer can be found in Documentation under Verifying Provider Tax ID - Advocate clarification
Name 3 reasons of why we would pend to Healthy Connections.
Answers vary.
Decision reasons can be found in Pend Criteria- Advocate clarification
What are some tips that will help with time management when working on reviews?
Answers may vary
What is the least amount of INN options we need to find in our research.
5, but you are encouraged to call more if you have time.
What do you feel your biggest strength is on NPR so far?
answers vary