CA/WV WGS,SPS, ACMP, and MCG

WGS

100

This key will take you back one screen (except in Corp. Menu)

What is F3

200

You change your WGS password in this place.

My IT Profile (change WGS password when you change your UID password.) 

300

You use this area when verifying PMG Grouping ID Code.

PA, then Select HMO/PPO, press enter. Enter 3 Character PMG code plus 3 zeros or 2 zeros plus 1 in PMG area. press enter, on entry select the SPS Grouping ID listed. 

400

This key is used to locate an active contract in the CI screen.

F5 

500

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

SPS

100

What do you click to view the provider Medicaid contract/contracts. 

What is View RMB

200

You search for a provider using this

first and last name

300

What are the two most important factors to accurately identify the correct PMG group and risk type?

What is PMG group name and Code

400

Only California selects this button to view the contract options

what is non-west

500

  What is 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

ACMP

100

This screen is the default screen (first screen after pulling up a case)

Case Summary

200

When sending a case to the PCR- what is the decision and reason?

Pend / Peer Clinical Review

300

This time zone is used for TAT

Eastern

400

Where would you look for medical records in ACMP

Fax tab, Fax log, or Notes tab, Case summary orange notification

500

Eligibility is noted on which 2 screens

Case Summary and Case Details/coverage

MCG

100

This is bolded   

What is a recovery milestone

200

Extended Stay and Common Complications are found in which type of guidelines

ISC's

300

Name the 4 variances

Positive, Medically necessary, Potentially avoidable, Does not apply

400

0-17 yrs old  

What is the age range for pediatric guidelines

500

These are the preferred guidelines in Anthem.

ISC's

More MCG

100

This type of guideline has BLOS

GRG's

200

What is the maximum number of ISC's you can use based on the main diagnosis drivers of the member

2

300

What was eliminated by OMPTA in the 29th edition of MCG

 What are Anthem Customized Guidelines

400

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

500

This guideline uses Stages during the hospital course

GRG's