WGS
This key will take you back one screen (except in Corp. Menu)
What is F3
Click this to view the Provider's Medicaid contract or contracts.
What is the View RMB button
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
Which guideline has Extended Stay & Common Complications?
ISC's
What is a max number of ISC's you'd want to use based on the main dx drivers of the mbr.
2
You use this area to locate PMG Grouping ID Code.
PA screen
What are the two most important factors to accurately identify the correct PMG group?
What is the PMG Group Name and correct PMG Code.
This time zone is used for TAT
Eastern
Name the 4 variances
Positive, Medically necessary, Potentially avoidable, Does not apply
What are the products we license?
What is ISC, GRG, RFC, CCG, BHG.
This key is used to locate an active contract in the CI screen.
F5
Only California selects this button to view the contract options
what is non-west
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 2 ways to enter Corp. Menu (check CPT codes, pricing & auth indicators.)
From KK screen hit YY, or F11 twice from CI screen
CA- one way to filter your results when looking up a contract for a provider or facility?
Line of Business Filter- Medicaid
OR
Network ID- CA-HMO Medi-Cal Mainstream/ LA Care
Case Summary and Case Details/coverage
These are Anthem's preferred guidelines.
ISC's
This guideline uses Stages during the hospital course
GRG's