WGS
This key will take you back one screen (except in Corp. Menu)
What is F3
What are the other types of insurance we look for in limited liability?
COB, MED, CCS -(for CA)
Case Summary
This is bolded
What is a recovery milestone
This type of guideline has BLOS
GRG's
You change your WGS password in this place.
My IT Profile (change WGS password when you change your UID password.)
You search for a provider using this
first and last name
When sending a case to the PCR- what is the decision and reason?
Pend / Peer Clinical Review
Extended Stay and Common Complications are found in which type of guidelines
ISC's
What is the maximum number of ISC's you can use based on the main diagnosis drivers of the member
2
You use this area when verifying provider contract status.
PA, then F8 to current check the contracts listed.
After logging into CCB, you should click on this
Middle row- Membership, claims, provider, codes, etc.
This time zone is used for TAT
Eastern
Name the 4 variances
Positive, Medically necessary, Potentially avoidable, Does not apply
W0081
What is an Anthem Customized Guideline
This key is used to locate an active contract in the CI screen.
F5
You click on this to locate the PMG code
M on Membership eligibility screen
Where would you look for medical records in ACMP
Fax tab, Fax log, or Notes tab, Case summary orange notification
0-17 yrs old
What is the age range for pediatric guidelines
Why would you use Extended Stay or Common Complications?
when there are variances or other health issues during the course of care and additional days / guidelines may be needed
What are the 2 ways to enter the Corp. menu (check CPT codes, pricing and auth indicators.)
From KK screen hit YY, or F11 twice from CI screen
Call Log or Change Key- in UM which do you use?
Change Key is ALWAYS used, NEVER Call Log
Case Summary and Case Details/coverage
These are the preferred guidelines in Anthem.
ISC's
This guideline uses Stages during the hospital course
GRG's