Authorization Status
This is the typical processing time for most authorizations.
What are 14 days?
Described as when the member ,or his/her physician believes that waiting for a decision under the standard time frame could place the member's life, health, or ability to regain maximum function in serious jeopardy.
What is "Expedited Authorization"
The amount of time it takes a faxed document to show up in Filenet.
1 hour
What is the name of BroadPath's Chief Operating Officer?
Who is Don Hubman?
This system serves as your primary source of truth for locating authorization status for participating providers.
What is Amysis?
When a nurse only approves that which is medically necessary and not the entire requested units.
What is Partial Approval?
This is the frequency that a standard authorization can be changed to an expedited authorization
What is "never"?
If someone requests an appeal we follow this procedure.
Transfer to appeals department
During a "ghost call" we must remain on the line for at least this amount of time.
30 seconds
This primary system where notation is recorded.
What is Envolve?
These two words indicate an authorization is still pending.
What are " no decision"?
If the "R" number is not found when verifying hipaa , we must verify these four items.
What are Name, DOB, Address and phone number?
We would provide these in lieu of someone requesting a reference number for the call.
First name , Last initial , and the date
What is the name of your Director on this account?
Who is Amy Breck
The letters "CMU" are short for this.
What is "Centralized Medicare Unit"
This word ,found under level of urgency in Trucare, means that the authorization is processed as standard.
What is "STABILIZATION"?
If a provider disputes that they are indeed participating we must follow this procedure.
What is Transfer to Provider Services?
In Illinois, all physical, occupational, speech, and home health therapy services for PAR providers go through this department.
NIA
This site is where we can find stats, faq's , and procedures.
What is Sharepoint?
The response to a Provider who requests an appeal on a voided Authorization.
We are unable to process since the Auth is voided.
What is the "Authorization Summary" screen?
We must search for a provider ,in Amysis, who does not know their NPI by using these two items.
What are an * followed by the tax id
When referencing HOME HEALTH , this length of time is considered a "FULL EPISODE".
60 days
The VP of Operations for BroadPath.
Who is Sean Hampton?
The brand name of the Centene division that sells and markets plans on the Health Insurance Marketplace.
AMBETTER