Carelon
Under which category would you find Interventional Pain Management?
What is - Musculoskeletal Guidelines
What type of policy/guideline is DME.00044? And what is the name of the policy/guideline?
What is a medical policy. Wheelchair Mounted Robotic Arm
What are bolded in MCG guidelines?
What are: Recovery Milestones
What product uses BLOS (benchmark length of stay) opposed to GLOS (goal length of stay)?
What are GRG guidelines (General Recovery Guidelines)
MG, SC, PUL (pulmonary), RF (respiratory failure), MD (musculoskeletal disease) are all what type of product?
What are GRG guidelines
Under which category would you search for CPT code 70487?
What is: Radiology Guidelines
Name 2 "filter by" options in OMPTA?
What are: Policy type, Status, Category, Subject, Document #
Under which guidelines would you find the Extended Stay and Common Complications found?
What are ISC's (Inpatient and Surgical Care Guidelines)
What are the maximum number of ISC's you can use based on the main diagnosis drivers of the member?
What are 2
Which would be chosen first if you had an ISC and a GRG both available for a case?
What is: ISC
List 4 categories of guidelines Carelon supports?
What is: Cardiology, Radiology, Sleep, Radiology Onc, Musculoskeletal, Rehab Services
Under which guideline would you find "positioning wheelchair seat cushion"?
What is: The Subject: Wheeled Mobility Devices: Wheelchair Accessories Guideline #:CG-DME-34
What are the 4 variances in MCG?
What are: Positive, Medically necessary, Potentially avoidable, and Does not apply
What type of guidelines start with W00 in MCG?
What is Elevance Customized Guidelines
What is the maximum number of GRG guidelines that can be used in a case?
1
Where are the total knee guidelines found?
What is - Musculoskeletal- joint surgery
What are the levels of the clinical hierarchy?
What is: Federal/State guidelines -> Member benefits -> Medical Policies -> Carelon Guidelines -> Clinical Guidelines -> MCG
What does 0-17 years old refer to in MCG?
What is the age range for pediatric guidelines
Why would you use Extended Stay?
What is when there are variances or other health issues during the course of care and additional days / guidelines may be needed
Name 3 products purchased in MCG that are used by Elevance?
What are: ISC, GRG, RFC, CCG, BHG, AC, HC
Under which category would you find CPT Code C1882?
What is the Cardiology Guidelines
Why would you click "current" in OMPTA to filter the search?
What is: to refine the search of CG or MP to current guidelines to "hide" the historical guidelines/policies
What are the preferred guidelines to use in MCG?
What are the ISC guidlines
Which product in MCG uses stages opposed to days for the hospitalization (ie. ISC, GRG, RFC)?
What are: GRG (General Recovery Guidelines)
What is the log in anthem9 / (password) nine used for?
What is the login to reach historical guidelines