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Types of intake
System,tools,resources
True or False
100

When initiating a new Out-Patient request. What are the 2 of the main pieces of information that we need to collect from the provider? And, if the provider does not have this what do we do...

1. The Service Start & End Date

If the provider does not have, we confirm if todays date (for the start), and if the default date (90 days) that auto populates is ok. 

100

What is the system that is used to initiate a medical PA request for the following states: TX, LA, and FL?

ICUE

100

We as C&S advocates, build PA requests for BH.

FALSE

200

This template should be used with which type of Intake request?

Request received by Phone

Contact Name:

Where caller is calling from:

Contact Phone:

Contact Fax:

Medical Record Number:

Clinical Contact/UM Nurse:

Is this case related to? MVA or Work related injury

Service Reference Number (SRN) given to?

Pended for Clinical Review? Yes

Tasked to:

IC Name/Title: , Intake Coordinator

Pending for Clinical Review – Acute Inpatient

200

Which tools and resources will be useful in assisting with the build of a PA?

  • C&S State Specific Grids (SSG)
  • C&S Prior Authorization List
  • CSP Auth Entry Grid
  • Documentation Templates/Notepad
  • Intake Work Queue Lists
  • Intake of Medicaid UM Requests
  • C&S Provider Intake SOP
200

We should only notate CSP FACETS if the provider calls in to obtain the status of a PA?

False: We notate both CSP FACETS and IQUE. 

300

Which type of PA provides a decision that can be rendered/completed by us while on the call with the provider if all guidelines have been met?

Administrative Approval

300

EPAL is used to confirm if PA is needed for which LOB, is it our MEDICARE or MEDICAID LOB, or BOTH?

MEDICAID

300

We build all cases except for? 

  • Building ER Admit Cases
  • Building Inpatient Surgery Cases
  • Building AIR, LTAC, and SNF Cases
  • Maternity and NICU Overview
  • Building Maternity and NICU Cases
  • Transplant 
  • Transportation

Transplant cases 

400

What information should we obtain and document from our caller when creating a NICU request?

Baby’s Medical Records number:

Baby’s Date of Birth:

Mother’s Member ID:

Mother’s First and Last Name:

Facility Name:

Facility Address (street, city, state, and zip code):

Facility TIN or NPI:

Attending Physician’s Name:

Attending Physician’s TIN or NPI:

400

Where are all of the Intake Job Aides housed?

In our memory

Knowledge Central

Intake tool

411 Resopitory

Intake Tool

400

Can a INN provider can Initiate a PA for an OON provider?

True

500

For a DME PA, for our Medicaid LOB what are the modifiers need to be included in a request for a new or rental item.

For Medicaid PA is needed if the cost of the item is greater than what amount for an INN provider. 

NU is the modifier used for "New" items

RR is the modifier used for "Rental" items

If the cost is greater than 500 for an INN provider PA is needed.