B&E
You do this to determine what the provider need
What is ask probing questions?
You must do this for every claim in order to properly document the call.
What is check the first box?
You do this before starting a case
You can find the DRG here
What is the Hospital Information tab?
to change the PCP, redirect the provider here
What is member Services?
When doing a provider search, you give them this amount of providers (if possible)
What is 3 providers?
You transfer the provider to Optum for additional information regarding these denials
What is R codes?
You will use one of these every time you access an authorization
What is documentation templates?
In this tab, you can see information about the member's primary physician
What is the PCP tab?
A referral can be backdated for...
What is 5 business days?
We do this for COB disputes
What is redirect to member services?
When the claim is in this status, you cannot discuss payment information or denials.
What is 11, pended status?
Only these types of authorizations can be backdated
What is DME and home healthcare?
You come here to see how many visits are remaining on a referral
What is UM History
You remove the last two digits of this number when pulling up claim image in macess.
What is Claim number?
Quoting benefits also includes this
What is limits and exclusions?
This is not a denial. It tells you how the claim was processed.
What is PXN - Network Standard Fee schedule?
You must state this when authorization is not required
What is NAR script?
Here you can see the reason a referral is pended
What is Prospective UM?
You must always check this when reviewing reimbursement policies
What is state exceptions?
Grace period is granted through ____
What is the state?
This number is used to pull a PRA on DOC360
What is EOB number/payment reference ID?
For CO, you can only create these kinds of cases
What is a concurrent/head in bed case?
You go here for additional information when the claim denies according to a reimbursement policy
What is clinical edits?
You use this system if you cannot find the claim in Facets
What is ECHO?