Research
What are the 3 ways Advocates can receive a NPR request?
Fax, email, and phone
What is one reason/scenario we would pend a review to Healthy Connections?
Answers vary.
What if you get routed a review that was intake by another Advocate and missing information needed?
Reach out to the contact person and/or the providers to gather more information.
What is the timeframe for talk therapy or med management availability?
Within 10 days.
Can be found in @handouts and Documentation
If you could live anywhere, where would it be?
Answers vary
When is it appropriate to use a general code from EncoderPro?
When there was not a code found by the provider or in claim history.
Name two examples of an automatic denial?
Answers vary
What is the overall process for doing a review on a restricted SHCC member.
Has to be started with the care manager. If member is not on the line we need to reach out to them before initiating the review.
The decision must be given to the care manager and they will reach out to the member.
How far back can we do a retrospective review for Medical and BH?
BH is 7 days.
Medical is 365 days.
Who is considered 'Prank Sinatra' on New Girl?
Winston Bishop
Answers vary and can be found in Documentation under Advocates<NPR<Super Specialty Services
What is the pain management timeframe when trying to find INN options?
30 days
You are going on vacation in a few days and have a few reviews in follow up that will not be finished by then. What is the best thing to do?
answers may vary.
What is one extra thing we want to try and get on BH reviews?
What video or GIF makes you laugh every time?
Answers Vary
What are some helpful resources to use while doing research? Any cool tips you may have learned from your mentors yet?
Answers may vary
You get a review for a patient to be seen at the the University of Utah Motor Neuron clinic for Muscular Dystrophy. Will you be able to approve, pend, or deny with this information?
What if a member refuses inn care options what do you do from there? (think in terms of a medical NPR)
Pend to Healthy Connections
Can we start a review for dentists?
Only if it is for a Medicare member.
How many minutes does it take Light to travel from the Sun to Earth
8 minutes and 23 seconds
When should we be verifying a providers Tax ID?
When the OON provider has multiple addresses on file in Facets. When found they need to include the ID under the providers information in call tracking.
Answer can be found in Documentation under Verifying Provider Tax ID
Name 3 reasons we would pend to Healthy Connections.
Answers vary.
Decision reasons can be found in Documentation.
What are some tips that will be help with time management when working on reviews?
answers may vary
5, but you are encouraged to call more if you have time.
What do you feel your biggest strength is on NPR so far?
answers vary