Guidelines
Send this for authorizations that are approved.
What is an Approval Letter?
What is the meaning of PT/OT & ST.
What is Physical, Occupational and Speech Therapy.
True or False
Custodial care is processed by intake
False: Custodial care is handled by Sean Norton's team. Custodial requests MUST be sent to their mailbox. NCH_OR_RadOnc_UMSS@CENTENE.COM
What must always match before working in both Omni and TC
What is member name and ID?
CMS- DME/HH is now being tasked to which auth owner's personal queue?
Who is Kyle Przypek
You use to to build PH authorizations
What is Authorization Guidelines
True or False
CMS 19 and CMS 21 no longer auto approve G0176 or S8940
True
Submit this for the vendor HHAX
What is a Service Now Ticket
Task created by customer service reps are commonly referred to as
What is an intent
MMA- DME/HH is now being tasked to which auth owner's personal queue?
Who is Ruzica Paunic?
If the request is to add units
What is create a new authorization
The Auth owner for a CMS Rehab that auto approves
Who is yourself.
True or False
LTC codes located on the cheat sheet result in a new authorization being created
False: Create a task to LTC UM
True or False
Send an email for requests that need further escalation
True. Send an email for urgent requests
(i.e- OOT (PH), P2P, clarification, member mismatch)
A MD signed order requesting additional HH/DME services from any of the sources below: (IP Svcs)
What is Discharge Planning (DCP)
True or False:
SCA requests need to be submitted to Sean Norton
False
You receive a CMS Rehab and it doesn't auto approve what do you do?
What is approve and send the approval letter.
True or False
J codes included with a future date IP admission will need to go to Biopharmacy.
False: It needs to be added to the OP S&P
Name one queue we work out of in Omni
What is Medical Management and/or Utilization Management
Prior to building a PDN case- if the diagnosis code is non billable, this results in?
What is a faxback?
The Level of Urgency for OP S&P
What is Standard
Tasking queue for MMA members 3 yrs of age or older and the services are in a free-standing facility
What is Medicaid Therapy Intake?
Service type for Rehab done in the home
What is Home Health
After an email has been sent, the Omni request is placed where?
What is my personal queue?
True or False:
G0176 can be included on a Hospice request when the PIC form is included.
(PIC:TFK Partners in Care: Together for Kids)
True.