UR Policies
The time frame to follow up on cases
What is 2 Days?
Does not allow retro reviews.
What is BCBS of TX/IL?
Weve exhausted all option and left with this
Monitor Symptoms
To bill without an authorization
What is BWOA?
The youngest on the team
Who is Taylor?
The turnaround time to respond to voicemails/emails
What is 24 hours?
Hold times are ridiculous but auths are worth it
Available for a fee
What is a Written appeal?
No authorization is required
What is NPA?
Recently engaged
Who is Paul?
The only time to offer GOP
What is for ECA/ANORS and when requested by family?
Complete forms via their web portal
What is New directions?
Usually has a turn around time of 48-72 hours
What is an Expedited appeal?
An in network exception
What is INE?
Left the snow for sunshine
Who is Matt?
Call 855-809-2015 is to reach them
What is UBH IOP
Warrants a single case agreement
What is no out of network benefits? NOONB
Close to the Kiwi Bird
Who is Maureen?
Provide the best two of these when we’ve reached a certain point in the case
What are denial options?
Has their name in their phone number
Who is Aetna?
A “fill in” exception made by some insurance companies
What is GAP?
Has a daughter that shares a name with someone on the team
Who is Carolyn?