A
Pre-authorization notification required. Inpatient Stay.
SIPN
Genetic testing must be performed by ?
Ambry Genetics or Myriad Laboratories
INN
In Network
Well Child
Not required if provider is in network
Remark code DENA ?
Services denied at the time authorization/precertification was requested
If matching authorization is not found in Aldera review ?
Identifi
Highest LOC
Inpatient Stay
All out of network providers require preauthorization unless the claim is for ?
Emergency room services, urgent care services, local health department services, or family planning services.
The services are rendered prior to/after authorization effective and expiration dates what is the remark code ?
AX
No pre-authorization is needed for any services
Cook County Health and Hospital Systems with TIN 366-00-6541
Preauthorization is not required until the 48th hour for ?
Observation Care
BRD
Business requirement document. A document compiled when gathering requirements for a new workflow and signed off by the client and Evolent subject matter experts
PMA is a ?
Non-displayable remark code and cannot be used to deny claims
The PREAUTH workflow queue contains claims
That have stopped for preauthorization verification.
When an Observation reaches the 48th hour
It should convert into an Inpatient Stay and require an Inpatient Authorization
Offset OS2 with ?
OC
They will require a separate authorization if they stay longer in the hospital
Newborns
Dental procedures are denied unless they are ?
Related to an emergency and performed in an ER setting.
If one day of the inpatient stay is approved, the entire stay is approved.
DRG Facilities
Ancillary Providers Related to ER Treatment in an in-network or out of network facility
No authorization is required for ER treatment.
Up to 4 days after deliver and 2 days prior to delivery no Auth required
Cesarean Section
For Physical Therapy/Occupational Therapy/Speech Therapy only count
Paid Visits
Remark Code GCA
Gold card providers are exempt from preauth
DME greater than_______allowed amount require
$1,000
Hearing aids limited to one every
Three years