The first step in determining the decision status of a referral/authorization
What is Auto Status Assignment (ASA)?
100
To ensure proper and complete processing of all referral coordinator job responsibilities.
What is the purpose of Policies and Procedures?
100
IUD's must have this checked prior to referral or visit so that the patient is aware of any copay
What is Health Plan Benefit?
100
Four edits per pay period
What is the maximum amount of time edits per pay period?
100
The referral routing guide can be found there
What is SharePoint under RC Toolbox?
200
To process an optometry referral you need this
What is Optometry Benefits
200
These types of referrals have 2 authorized visits in the general tab of a referral request
What are Procedure and Radiology referral types?
200
"Approved for Evaluation and Initial Treatment with 3 Follow Ups Authorized"
What is the note added to all Physical Therapy referrals?
200
Annually in June
What is the month that self evaluations through ECAT are completed?
200
Policies and Procedures are detailed guides to referral processing and are updated often, they can be located in this area
What is SharePoint, under Medical Management Policy
300
Evaluations for Allergy, Derm, ENT, OB and GYN for Anthem/Vivity patients
What type of referrals is "Anthem Speedy Referral" approval reason used for?
300
NEVER modify an existing authorization, ALWAYS reissue a new authorization
When can you modify an existing authorization?
300
"DIAGNOSTIC WORK-UP INCLUSIVE OF DIAGNOSTIC MAMMOGRAPHY, ULTRASOUND, MRI, TOMOSYTHENSIS AND BIOPSY IF INDICATED"
What is the note added to all Diagnostic Breast Referrals?
300
The period of time post operatively when patients do not need a new referral for services provided by their surgeon related to their procedure.
What is Global Period?
300
Here you will find the CPL, RC Toolbox, Referral Routing Guide, Forms, GI Information, Radiology Codes, and many other resources to assist you in your daily duties.
What is the SharePoint Portal?
400
General Opthalmology will now auto approve if sent to specific providers. These providers are paid for services per patient, not per visit for specific codes.
What is the Ophthalmology Capitated Agreement?
400
I. Insurance Eligibility Updates/Changes
II. TOC Provider Updates
III. Referral Issues
IV. Contracted Provider Updates.
What are the CRM types created by referral coordinators?
400
Patient MUST be notified via phone; referral MUST not be mailed without patient consent
What is the notification requirement for Abortion/TAB referrals?
400
Adding the appropriate facility to the label.
What is the additional step to naming convention for transferring faxes to the BC/RC?
400
mcmfhealthplanaccess@memorialcare.org
What is the email to gain access to the health Plan websites?
500
All RUBY providers and POS MUST be reviewed by ACM
What is the level of provider or POS that will never auto approve?