Referrals & Initial Screen
Completed by the CC after a successful referral has been submitted.
What is the initial screen?
Inpatient and Outpatient
What are the two types of Authorizations?
The number of days the CM has to outreach the member after discharge from the hospital.
What is 3 days?
This part of the Care Plan must have a target date.
What is the goal?
I could go here in TruCare to see all of the group queues that I have access to. (Hint: There are two places!)
What is the "User Dashboard" and "Tasks" icon?
Meets Criteria to proceed.
What is a successful referral?
The duration of a DME Auth. Request
What is three months?
Contains the question groups: HIPAA, Post Discharge, Change in Condition, Social Determinants, DME.
What is the Transitions Of Care Assessment?
High priority
What is the priority of one of the goals in a member's Care Plan?
Can only have 5 members opened simultaneously.
What is the Member Slider or Open Members?
This is used to screen and identify a member's needs for care coordination activity.
What is a referral?
The case type appropriate for members who are enrolled in active, specific, Care Management programs?
What is Programmatic Care Management?
The name of the note template used after outreaching the Discharge Planner
What is an ICT Note?
When searching for a problem, only select problems with this problem ID.
What is HF2021?
In progress or closed.
What is the case status?
A member, physician or other healthcare provider, and/or caregiver
What are possible referral sources?
This type of note contains the following: New request, No Auth. Needed, Member's Address, Medicare ID#
What is a prescreen note?
This task activity name that will alert you that a TOC Assessment is needed.
What is "Assessment Due Member Hospitalized"?
This is added when the Care Plan PGA status has been updated and discussed with the member.
What is "Member Acknowledgement"?
This is automatically generated and then mailed to a member after they are enrolled in a program.
What is a "Welcome Letter"?
The first step in the Standard Care Management Workflow.
What is "Create a Referral"?
The 'From date', 'To date', Stay Level, Service Type, status, servicing provider, and the procedure code are all found here.
What are 'line items' within the authorization?
The timeline for outreaching a member post discharge.
What is: Three times within the first week and again on weeks 2, 3, and 4 if the member is still not reached.
The problem, summary of discussion, intervention/education, and next steps are included in this.
What is a Care Plan Update Note Template?
Member Profile can be assessed this way.
What is: In TruCare, click on the globe icon and scroll to Member Profile Web Application.