Workflow/CMS Compliance
The type of date/time that the initial task due date should match.
Request received date and time.
You should never do this before checking PAR status.
Check codes in the NPL.
The only plan that the NPL does not apply to
Traditional Choice (TC)
The form you send when the member is from the state of California and is apart of an IPA
Delegated fax form
What you should do before verifying codes in the NPL. (before checking PAR status).
Opening member in Medcompass.
The tool used to search for appropriate re-routing/tasking for a particular plan
CCU Triage Tool
Correct course of action when unsure if case should be expedited or not.
Reaching out leadership/designated IQAs to reach out to Stateside clinician's for assistance.
This does not automictically mean that Aetna is a member's secondary insurance.
Seeing "COB:Yes".
Tool used to verify specific precert requirements for a plan sponsor
Plan Sponsor Tool (PST)
This is what it is called when clinicals are attached a month after a case is cancelled.
Red flag.
This is where you find the details or the Oak Street Delegated Vendor.
Health 360-Notifications-Delegations.
That law that ensures protects the privacy of patient's health information.
HIPAA LAW
This can result in a Medicare CAP error/compliance issue if not included in a case.
Requestor role.
This job aid provides instruction on how to handle cases with delegation.
Standard delegation
The full meaning of the Acronym "HIPAA"
Health Insurance Portability and Accountability Act