Member Search
What is the New Request screen used for?
This screen is where every new precertification begins
What must appear in the Plan Service Info drop-down before you continue building a case?
UR1
This section displays all ICD-10 codes associated with the case
Diagnosis Details
This note template should be used anytime you provide case status information to a caller.
Intake: Status Check
This button is used to modify provider, diagnosis, DOS, and insurance information
Edit Auth?
This symbol can be used to expand search results when a member or group is difficult to find.
% symbol
What ICD-10 code should be entered when the caller does not have a diagnosis code available?
R68.89
This tab displays the servicing facility and attending physician.
Provider Info
This type of note is used to communicate important information directly to the TPA or client.
Claims Payor Note
This type of information cannot be changed on a case once built.
Setting
Before creating a new case, why do we need to check Member Search Results/Patient History?
You should always check this area for possible duplicate cases.
What must be read carefully after clicking Continue because they determine whether a case should be built or not?
Rules
This button allows an Intake Associate to add another CPT code to an existing case
Add Procedure Button
This should be copied into intake notes when client-specific instructions appear during case creation.
Rules
When changing physician or facility information, this must be done before saving.
verify all information and document any changes
What two identifiers are required for HIPAA verification?
Name and DOB
What urgency is used when a patient is admitted through the Emergency Room?
Emergent
This page should never be read to callers because it contains confidential review information.
Case Summary
When documenting network status, this phrase may only be used if both providers have the same network status.
"Both providers are in network" or "Both providers are out of network"?
This action should not be taken if a provider calls and says a previously built elective case is now urgent.
Urgency Type
What information may Intake read to the caller?
Group Plan and Cardholder Name
What urgency is selected when a provider specifically states the request is urgent or stat?
Urgent
This section displays the Program Name used to identify the group when speaking with providers.
Case Information
These letters are used throughout Intake note templates to answer required questions.
Y and N
To save any changes made in Edit Auth, you must click this button.
Save