UR
What does UR stand for?
Utilization Review
What is the most overlooked piece of information on an referral?
Physician
What happens when you save an Emoji to your file notes?
Will not save.
What does IV stand for?
Intravenous fluids
Where do you find that?
Has been asked about everything.
What code am I G0299?
RN
What do I stand for: HHC?
Home Health Care
Name four states that require an UR?
AL, CA, CT, KY, LA, MA, MS, TN, TX
What does one forget that effects us all?
Being logged into the phones.
What is the fax number?
866-535-0955
What is the average margin you up-charge for medication?
15%
Did you look in?
SIR
What code am I G0156?
Home Health Aide
What do I stand for: RN?
Registered Nurse
What does RFA stand for?
Request For Authorization.
I am apart of a line item that is normally is forgotten?
The date range for the authorization period.
Josie's most used phrases?
Please hold/Fruit for thought
What does Per Diem mean?
Daily rate that is charged per drug to cover all administration and supply cost.
I am a conversion file where do I look for past invoices?
viaOne/SIR
What code am I G0152?
OT
What do I stand for: CMA?
Certified Medical Assistant
What should you do if you are asked to send in documents to UR from the Adjuster?
Fax them over.
I am sometimes lost in the paper trail and forgotten.
I am to be uploaded into your files.
What am I?
Authorization emails.
Our job to the client besides staffing services is?
Show cost savings.
Lab work is needed who is responsible for to pay the invoices?
The Adjuster.
What is Transportations extension?
50338
What code am I G0151?
PT
What do I stand for: RPh?
Registered Pharmacist.
What should you do if you are waiting on a UR decision for services to continue?
Place referral on hold immediately!
I help remind you of the next steps you need to do each time you open a file.
What am I?
POA
I can't get into Mitel what do I do?
Call IT
When Medication is overnighted.
What is the standard delivery time frame?
8:00am -11:30am
Do we have to have on our camera's?
Yes, every Tuesday at 2:30pm
What code am I G0153?
ST
What do I stand for: ARNP?
Advanced Registered Nurse.
What is the standard return around time for the UR decision to be rendered?
5-7 days
I am a telephone call how should I be documented in the file?
Who, What, Why and When.
What are IT's hours?
24 hours/7
What are the common frequencies used when Medication is prescribed?
4, 6, 8, and 12 hours
How do I confirm who the Adjuster is?
viaOne/SIR
What code am I REV Code 120?
SNF
What do I stand for: PA-C?
Physician Assistant- Certified
How can you obtain an UR decision letter?
Must have all the answers.
Ask the Adjuster, look in SIR, call UR directly.
I am another system and I am very helpful when things are missing.
Who am I?
viaOne or SIR
What number do you give out for after hours/on call?
866-535-0905
Which pharmacy provides education form a Licensed Pharmacist when asked?
All
What is email for HHC intake?
us-hhc@sedgwick.com
What code am I D9992?
Dental Case Management per hour
What do I stand for: NCM?
Nurse Case Manger
UR Decision for Approval/Denial has been made what are the steps for each Approval and Denial?
Approved notify the Vendor and provide an updated authorization.
Denial notify the Vendor and have them discharge the Injured Worker immediately.
You must have both of me for all orders/services, except for Aides.
What am I?
A medical prescription/H&P
Zebra is spinning. What do I do?
Wait.
Where do you find the Adjuster's mailing information?
Under the adjuster section and click the pencil.
Where do I send the billing inquiries to?
notesandinvoices@careworks.com
What code am I D2740?
Crown
What do I stand for: ADJ/CE?
Adjuster/Claims Examiner
If an authorization is set to expire prior to the UR decision can you ask the Adjuster for approval for services while waiting for the outcome?
Yes.
I am sometimes pushed aside on your list but I am just as important.
Follow-ups
What is portal Payment?
A Clearance House that is used for insurance companies to send payments to the Vendor electronically.
What state is First Call Pharmacy located in?
Louisiana
Who don't I send payment escalations to?
The Adjuster.
What code am I 99212?
Doctor's visit 10 min - established patient
What do I stand for: JI?
Josie Irizarry
What are the steps for when an adjuster overrides the UR decision to Approve or Deny?
Must list all.
Contact the Agency immediately and advise services are authorized or not authorized.
if Approved-Send updated authorization
If Denied - Advise Vendor to discharge the patient.
What is the true meaning of the abbreviation Rx?
Is the symbol of Prescription Drug.
Double Jeopardy!
What does the 15, 30, 45, 60 day net payment term mean? What is our normal payment term we offer?
The date the payment is to due to the vendor's.
30 day-net.
What is the most common medication prescribed in Home Health?
Vancomycin
Time is our meeting?
2:30pm EST
What code am I S9500?
Per Diem for IV
List all the acronyms for the divisions in Ancillary?
HHC, TRN, INT, DME, Dx,