Note Subject/Event level documentation
MD office, Ambulatory surgery center, Hospital
What is Place of service?
Information confirmed back to requestor.
What are Diagnosis & Procedure codes?
Information required to determine member coverage.
What is the COB?
555-123-4567
3510 Big Tree Lane
Tampa, FL 30256
What is additional info that CMA verifies for case creation?
10 Seconds
What is the call greeting timeframe expectation?
Applies to all Precert requests that pass manual E&E.
What is Auto-approval eligibility?
Provides description of service.
What is CPT code?
ASD/360 screen provides this information.
What is Eligibility?
Where discrepancies are documented for case creation.
What is in case note template?
2 - 3 mins.
What is the expressed hold time for caller?
Applies to IP or Outpt service type for example CPT 43775.
What is surgical service type?
Provides guidance on the codes that should be added to PX tab.
What is TPS (Total Payment Solutions)?
Department that confirms plan details.
What is Provider/member services?
Captures the name of the caller/phone number and fax number.
What is Contact information?
15 days/48hrs/45 days
What is TAT?
Determines if a SOS review will apply.
What is Place of service?
Informs if medical review is needed.
What is Quickbase NPL tool & tasking tool?
Medical..NO other coverage exists...01/01/2016...Trad
What is documentation for COB?
Admitting = John Hopkins Hospital
Attending = John Hopkins Hospital
Facility = John Hopkins Hospital
What is CMA makes attempt to update admitting/attending information?
Live person to person connection.
What is a warm transfer ?
Applies to Inpatient, Medical, MCG gives # of approve days.
What is Precert status?
A tool that houses resources for all different roles.
What is CS Hub?
Where benefit specifics are housed.
What is the Plan Sponsor Tool?
Where provider demographics are updated.
What is provider details screen?
Scenario: Additional research is required by CMA, upon researching CMA checks back with caller, thanks caller for holding and provides resolution.
What is proper hold protocol?