Roles and Responsibilities
This Department is responsible for authorizing requests for Behavioral Health and substance use disorders.
What is Behavioral Health Utilization Management?
Virginia Premier has this many Governing Bodies.
What is three?
This is the turn around time requirement for a concurrent review request?
What is 72 hours?
True or False: QNXT is a read only application?
What is true?
This is the department/staff that generally receives the authorization requests and enters the request into JIVA.
What is Authorization Secretary?
What does NCQA stand for?
This is the turn around time requirement for a retrospective review request.
What is 30 days?
This is the location in which I can find the members eligibility information.
What is member eligibility or member summary?
This department is responsible for authorizing requests for Medical Health Services.
What is Medical Utilization Management?
This is a type of element that, according to NCQA, must be met 100% of the time.
What is a 'must pass' element?
This is the turn around time requirement for an Urgent (inpatient) request.
What is 24 hours?
This is the location where I will find the members address and phone numbers.
What is member details?
This person is the primary point of contact for the members, and works with the member to create care plans and facilitates successful transitions of care.
Who is the Care Manager/Care Coordinator?
True or False: Virginia Premier is not required to maintain NCQA Accreditation.
What if false?
This is the turn around time requirement for a Non-Urgent (outpatient) request.
What is 14 days?
This is the location where I will find the members waiver information.
What is member attributes?
This supporting staff is responsible for assisting the member with community benefits/resources such as food stamps and linking the member with DSS.
Who is the Social Worker?
True or False: Per NCQA, you must follow their guidelines for turn around requirements, even if they are not the most stringent.
What is false?
This is the time when the 'clock starts ticking' for turn around time requirement compliance.
What is when the request is received?
This is where I will find if a providers Par/Non Par status.
What is Provider Summary?