Request Profiles
Evalauate and Treat
What is P1?
Processed within 24hrs, STAT, today.
What is emergent?
MTF
What is Military Treatment Facility?
Authorization Main, Member Snapshot, Correspondence, Intake are all located in this tab.
What is General Information?
Internal list for limitations, exclusions, verification of demographics.
What is the Provider List?
Evaluate Only
What is P3?
Processed with normal timeframes.
What is Routine?
EDI
What is electronic data interface?
The diagnosis code is verified (specific) using this sub tab.
What is Authorization Main?
Sends to another team for processing if for testing, labs, procedures (and have not been trained).
What is Route Auth?
Specialty Referral Extension
What is P4?
Request received AFTER services provided to patient
What is retro/retrospective?
ADSM/ADFM
What is Active Duty Service Member and Active Duty Family Member?
Verification of the "subscriber" or "dependent's" demographics.
What is Member Snapshot?
Work Goal, Queue, Reference Number, and Disposition are found here.
What is the Assignment Task Log?
Requested Specialty: Urgent Care
What is P45?
Processed within 72hrs, ASAP
What is urgent?
PCM
What is primary care manager?
Search the "servicing provider" either "named" provider or radius search.
What is the services tab?
Pends a case when the agent needs to ask a question.
What is Pause?
What is P126?
Request received before services are provided
WARF
What is Web Authorization Request Form?
Select checkbox when placed on 100% audit after training.
What is Correspondence?
Assigns a case to another team if the request indicates IOP, SOT, PHP, etc.
What is disposition (inpatient)?