NOA
WHAT DOES NOA STAND FOR?
NOTICE OF ADMISSION
HOW OFTEN DOES BIA FOLLOW UP ON A CASE?
EVERY 2 BUSINESS DAYS
WHAT IS A 3RD PARTY THAT MIGHT BE LISTED IN THE RTE FOR HUMANA?
CONVIVA
HOW OFTEN DOES THE RTE NEED TO BE RAN?
IT MUST BE VERIFIED IN THE SAME MONTH AS THE DOS
WHAT DOES HIGH SEVERITY MEAN?
THIS IS AN APPROVAL
WHEN DO WE PROCESS A NOA?
1 DAY POST DC
WHAT DOES NRD STAND FOR?
NEXT REVIEW DATE
DOES THE CONVIVA TPA HAVE THE SAME FAX NUMBER AS HUMANA?
NO
WHAT SHOULD YOU DO IF YOU HAVE A MISMATCH OF INFORMATION?
FIX THE MISMATCH OR ADDRESS IN YOUR NOTE
WHAT DOES LOW SEVERITY MEAN
THIS IS A DENIAL
WHAT CLINICALS DO WE SEND FOR A NOA FOR A MEDICAL CASE?
H&P, ED NOTES, SIGNED PROGRESS NOTE SIGNED BY A PHYSICIAN.
IF THE CASE IS A CONFIRMED RETRO REVIEW, WHAT IS THE NRD?
5 BUSINESS DAYS OR 1 FULL WEEK
2
WHAT COLOR IS THE MISMATCH ALERT?
ORANGE
WHICH PLAN HAS HIGH AND LOW SEVERITY LEVELS?
AETNA MEDICARE
WHAT DAYS DO WE FLAG FOR WHEN PROCESSING A NOA IF THE CLINICALS ARE NOT AVAILABLE?
DAY 1 & 2, THE ACTUAL DATES ARE NEEDED.
WHAT IS THE PRECERT FIELD IF YOU NEED CLINCALS?
HOW CAN YOU LOOK IN THE WQ FOR UPGRADES?
WHAT DOES RTE STAND FOR?
REAL TIME ELIGIBILITY
CAN YOU PROCESS AN APPROVED AUTH ON THE THE AVAILITY PORTAL AS AN APPROVED AUTH?
NO, YOU MUST FIND OUT IF IT IS HIGH OR LOW SEVERITY
IF PATIENT WAS OBS 1.25-1.26 AND ADMITTED ON 1.27. WHAT ARE THE DATES WE FLAG FOR?
1.27, 1.28
CAN YOU DO 2 PORTAL CHECKS IN A ROW AS YOUR FOLLOW UPS?
IF THE 2ND VISIT TO THE PORTAL IS THE EXACT SAME RESPONSE THEN A CALL MUST BE MADE TO THE PAYOR.
DOES HUMAN OFFER MEDICARE, MEDICAID AND COMMERCIAL PLANS?
YES
IF YOU GET AN ALERT FROM MEDICARE THAT THEY ARE SECONDARY, WHAT DO YOU DO?
LOOK FOR THE PRIMARY AND DO NOT LEAVE THE MEDICARE AS PRIMARY.
HAS THIS BEEN FUN?
YES OR NO