Basic Call Flow
What is the standard refresh timeframe that you should check back with your caller once placing on hold?
2 Minutes
What is the Task type that is used for tasking for Authorization Modification in TruCare?
Clinical Information
Where will you find if a member has another insurance coverage in TruCare Classic?
Other Coverage in Eligibility and Benefits
True or False: Observation authorizations do not require authorization if expected to exceed 48 hours or more or if the provider is non-participating.
False
When an authorization is not found in OMNI, what is the correct checkbox to be utilized to initiate the OMNI Case?
New Utilization Management
At what point during the call should you utilize a "Willingness to Assist" statement?
Immediately following their reason for calling
What type of task is modified/edited when utilizing the Expedited Review process in TruCare?
Clinical Review
Where in TruCare Classic can you access the market guidelines for each state?
TruCare Launch Pad
What is the most common generic provider specialty code found on most authorizations and mentioned in the authorization guidelines?
SP99
If an authorization decision is upheld through the appeals process, what is typically the providers next step to overturn the denial?
Medicaid Fair Hearing
True or False: Agents should always confirm member and listed provider information first before releasing authorization information.
True
What section of the workflows can you find out how to do a fax search in FileNet or Faxcom?
Navigation
If you are looking for a delivery authorization for a newborn, where in TruCare will you likely find it?
Mother's profile under Birth Events Summary
What type of service codes will be found on a Hospice Authorization in TruCare?
Revenue Codes
The "briefcase" icon in TruCare Classic will usually show you what information for the member?
The members' Case Manager
What TruCare queue should all Callback Tasks be assigned to when taking calls for Inpatient BH notification of admission?
FL BH UM Notification
Appeals information and mailing addresses for each market can be found in what section of the agent workflows?
Resources by Market
What button(s) can you select in the Authorization Summary section to review the denial rationale when no correspondence is present in TruCare?
Advisor Reviews or Clinical Reviews
Outpatient Services authorizations will typically be built for what length of time or "auth span"?
90 days or 3 Months
Medical Transportation Management(MTM) is the transportation vendor for which member plan type for Florida?
Children's Medical Services (CMS)
When are we allowed to utilize a cold transfer?
Transferring to external numbers or to Peer to Peer.
True or False: All Peer-to-Peer emails should always include three time slots for provider availability for review not to include the first 24 hours of request?
True
If the member's BHP in TruCare shows Region 9, 7, 11, etc..., what is their plan/benefit type?
Long-Term Care
U1, U2, U3, U4, & U5 are modifiers for what specific type of Rehab/Therapy Services?
Expressive Therapy
What is the name of the proper workbasket or folder view in Filenet to view faxes for any market?
Medical Management