Clinical Information Requirement Grid
Case scenario: Member has been diagnosed with breast cancer and needs a breast reduction are photos required?
NO
What does COW stand for?
Claim Optimization Workspace
What did Ms. M (Ashley's daughter) feed/try to feed the dog this morning?
Apple cider donut
True or False: ASO/Self-funded follow state mandates.
False
If Clinical Information was received online via SYSTEM_UHCOL or SYSTEM_PAAN. Would we still need to request clinicals?
NOPE. Use the drop-down option in the macro to add an ETS/ATS comment that clinical was received via UHCOL/PAAN
What types of cases do we run the service history tracker for?
Sclerotherapy(Veins), OT/PT/ST/Chiro, and Infertility.
Where is Kristy from?
Texas
True or False: ASO/Self-Funded uses the state law report to determine is an AOR is needed.
False
Case scenario: Member is getting sinus surgery CPT codes 31253, 31256, 31287, and 61782. Are photos needed?
NO
Limited-Service Tracker > Appeals > Show Pends. Select the appropriate service.
Who does Spicy Jalapeno love to bully by telling them to moooove?
The dogs
True or False: FI follow state mandates.
True
After looking at the at the clinical information requirement grid, what document would you use to grab the information needed for your clinical information fax template?
Medical Records Documentation Used for Reviews
Claims system: UNET
Which system would you use to pull your service history tracker?
COW (Claims Optimization Workspace)
Kiana is the best trainer ever true or false.
True (duh)
True or False: ASO/Self funded plans pay for their own claims?
True
Case scenario: Member needs a breast reduction to treat back pain does case need photos?
Claims system: USP/Cirrus
Which system would you use to pull your service history tracker?
Limited Service Tracker with in the Macro
Where can you see the pictures of our coworkers?
SharePoint
True or False: SOI, SOR, SOS:TX. ASO/Self-Funded peer-to-peer is mandated.
False