Tap IN!
An Observation is OPNR under this many hours.
What is 48?
The Relationship Type for Cross Rendering
What is N?
The Alert Messages, The PBM, and Managed by NIA.
What are the GST Hotspots for Vendors
I am your mainframe, your homepage, your start menu. Who Am I?
TMCS/TNAV
Where an ACA/Choice would send a request with an Out of Network provider.
What is pend to UM?
The next step after confirming that a fax request is a CSR.
What is pend to the UM?
The reason for sending Outpatient Therapy requests to UM review for Cross
What is exhausted benefits?
The primary type of requests approved by Avalon.
What is Genetic Testing?
You will put all of the contact information on me. Who Am I?
TCC1
The email that images for focus review requests can be sent to.
What is MEDICAL.AUTH.REQUEST@BCBSSC.COM?
The person who can approve an Inpatient ER admit for DX: U07.1 at an in-network facility.
What is a CSA?
The Type of Service requested by LifeHME
The Vendor that Acosta member's are managed by.
What is Quantum?
I am your handy dandy code finder! Who Am I?
PNV1
Someone has called on an Acosta member to initiate auth for OP surgery for CPT code 27447, so the CSA should do this.
What is refer to Quantum?
The number of days approvable for heart failure.
What is 2?
The Threshold Amount for Seaboard Corp.
What is $500?
Hershey has called on a Pharmaceutical Associates, Inc to check the auth status on a PET scan he submitted auth for 3 days ago. This is how the CSA responded.
What is refer Hershey to NIA to check status?
I am immediately after the TCC2 screen when you are building a case. Who Am I?
EOC/THKM
When someone has called on a Publix member to request authorization for an ACL repair surgery the CSA should do this.
What is approve the authorization and provide caller with auth number?
The next step after receiving a Routine Delivery Notif for a dependent member with SHP and confirming HIPAA and Eligibility.
What is Build WIP and Pend to DMATWKLD
The Type of Service for S5035
What is Home Infusion?
Pringles has called on a Seaboard Corp member for a buy and bill request on medication, Cosentyx. This is what the CSA responded.
What is referred to MBMNow to obtain precert?
Shift F5 to get to me! Who Am I?
TMPL/Health Care Finder
Someone has called on a The GEO Group member to initiate auth for OP services for a J1439 (buy and bill) CPT code, so the CSA should do this.
What is Pend to Pharm UM?