March Fun Facts
What is the March Birthstone
What is Aquamarine
When does the expedited timeframe start when we receive the request from outside of the UM department ?
What is from the date and time we receive it.
Can Untimely NOPA Codes be denied?
What is Yes, if the primary code is being denied.
What job aid are clinical staff to reference for applicable guidelines for authorization request.
What is Selecting Applicable Guidelines for Clinical Authorizations Requests
What is No
What is a day of celebrating Irish Culture?
What is St. Patrick's Day
When does the expedited timeframe start when we receive the request within the UM Department?
What is when the UM department receives it.
What can we validate in CSP?
What is verify eligibility, check claims, review benefits, view copay information, view Part D benefit
If a request is a high cost or Car T what does it require?
What is Medical Director Review
What if provider states S Code they are requesting is the correct code
What is send the case for review for non-covered service.
What is was invented in March 1886?
What is Coca-Cola
When does the standard timeframe start when we receive the request from outside of the UM department?
What is we start from the date/time the plan receives the request.
What do you do with a NOPA code that is on a late notification request for a non-contracted provider?
What is send a UTP letter for the NOPA codes
Who is the preferred provider for Infusions/Nutrition for AZ?
What is Optum.
When reviewing the request for Medicare LCD coverage what must you validate?
What is the state the services are being performed.
March is National _________________Month
Can a Part B Pre-Service Request be downgraded to standard?
What is No
What does NDC stand for?
What is National Drug Codes
What should you do if you receive a non-covered code?
What doe post service claim review require?
What is a medical necessity review
What are the astrology signs for March?
What is Pisces and Aries
I order to ensure your notification is timely, how many times should you conduct verbal notification of the decision?
What is 3 attempts for verbal notification of decision.
What should I do when the dosage requested is over the allowed amount?
What is conduct clinical outreach to validate the correct amount the requestor wanted to request.
What is required if member is a clinical trial?
What is pharmacist review
What is important about reviewing Florida DNSP for HIDE Plans?
What is review of the customer's Medicaid coverage?