Review This!
PAR that is reviewed as this Request Type submission is because a longer Turn-Around Time could result in a delay in the Member receiving care or services.
What is a Rapid Review?
Allowable provider types for the servicing provider over DME services.
What are supply Providers, some Pharmacies, or Prosthetic/Orthotic only suppliers?
What is one exclusion where OOS services do not require PAR?
What are Emergent admissions?
This is an expression of dissatisfaction by a Consumer expressed verbally or in writing regarding an organization’s products or services that is elevated to a complaint resolution system.
What is a Complaint?
Timeframe for Rapid Review
What is the same business Day if the request is received prior to 2:00pm and within 1 business day for all request received after 2:00pm?
Retroactive PAR requests are accepted only up to 10 business days from the date of service for these types of services.
What are Private Duty Nursing (PDN) and Pediatric Long Term Home Health (PDN) services?
For Private Duty Nursing (PDN) services, all supporting documentation must be within ___ days of the start of the PAR
What is 60 days?
This Genesys Status is to be used when you have designated off the phone time to work on faxes OR you are working with IT for system resolution.
What is the Busy Status?
CSRs will send this type of document and form to providers when completing a PAR for OOS services.
What is a NEMT Fax Notification?
This is to be clicked at the end of every call.
What is the Done button?
These two service types can only be requested for a max duration of 90 days.
What is Imaging and Surgical services?
These types of supplies are specifically related to the active treatment or therapy for an illness or physical condition; they are non-durable, disposable, consumable and/or expendable.
What are Disposable Medical Supplies (Supplies)?
CSRs are able to send this if the provider requests to speak to a reviewer who is not currently available or if they require a call back for clinical clarification on a submitted case.
What is a Clinical Callback request?
This is the required type of transferring all calls, otherwise know as a warm transfer.
What is a Consult Transfer?
Otherwise known as an administrative denial.
What is a Technical Denial?
A PAR review that is required to be done on an _____ basis because a delay could:
What is Expedited Review?
When should providers use a RA modifier?
What is a Replacement of a DME, orthotic or prosthetic item?
All transplants EXCLUDING _____ and _____ REQUIRE Prior Authorization (PAR)
What are cornea and kidney transplants?
What is the RAE for Garfield county?
What is Region/RAE 1 Rocky Mountain Health Plans?
Explain the steps for placing an extension request
1. Create Task
2. Work task
3. Click Extend
4. Click yes on pop up
5. Fill in required fields under R02.
6. Click submit
7. Close task
8. Leave note/interaction
No PAR required for sessions 0-12 for this service type.
What is Speech Therapy (ST)?
Las Cruces, NM is a bordering town/city of Colorado, true or false?
What is False?
A PAR is not required when Medicare, Medicare Advantage plans, or private insurance has done what?
What is made primary payment on the claim?
Where should providers go to add new users?
What is the set up area?
Explain how to reactivate an existing user account in the management portal.
1. Select security> manage users
2. Search using the username, NPI, or name of the user
3. Select Edit
4. Select activate then save