General
What is concurrent review?
Changing from OP to IP after a procedure has been completed and is handled by the HP, and if requesting extra days of stay.
What is the expedited TAT for BCBS MI?
48 HRS
What are the hours of operation for the P2P dept?
9am to 6pm
What is the TAT for 1st level expedited appeal for TX?
It is up to 72hrs.
These 3 types of emails are sent to TF.
Add provider/facility, eligibility inquires?
When can a PSCR not be done?
On a denied case
What is the standard TAT for BCBS TN Plan?
7 Calendar days
I am the Peer to Peer Team Lead, who am I?
Chade Whipple
Do we handle ENT for New Mexico Ambetter Marketplace?
No, we only handle MSK.
If a provider/facility is OON what is the next step.
Nothing? TF will verify all OON.
Can CPT codes be added or changed on a finalized case?
No, we need a new case with all requested codes or request a PSCR.
For BCBS TN when can a P2P be done?
Any time before procedure.
I have this type of medical plan, so I only receive a P2P for educational purposes only!
Medicare
Can A PSCR be done for WC Medicare?
No, they would need to reach out to the HP for further assistance.
The supervisor of Task Force team.
Who is Asja Jefferson?
Can I add a CPT code to a case in review with no nurse assigned?
Yes, also email NR for awareness.
When can HZN Medicare case be resubmitted if denied?
After 60 days from denial
Name 3 P2P Coordinators.
Paolo Wilson, Christina Quintana, Desiree Yule, Marcella Valdez, Michael Thompson, Bre Collier, Ericka Mack, and Eliany Cepeda.
In order for TP to review SCA the case needs to be?
Case needs to be approved.
TF Hours and operation.
If PO calls in to update provider NPI on approved case, can this be done?
Yes, as long as it's the same practice and TIN is not changing.
Which states do we handle for BCBS?
4, HZN (New Jersey), Capital (Pennsylvania), BCBS Tennessee, and BCBS Michigan.
Following the conclusion of a P2P call, the case determination should be updated within what timeframe.
What is 24 hours?
Do we handle WC KY for MSK?
No as of 2/1/2024 we do not handle KENTUCKY for ALL lines of business both WC and CEN
To add a provider/facility to case what do we use.
What is the TF email template?