Authorizations
This portal is where you can locate an approval for Blue Cross Blue Shield.
What is Cohere?
This team manages cases once the UM Status has been updated to Denied.
What is the Denials team?
This Pillar Goal we consistently knock out of the park with a DNB average of less than 3 days.
What is the Finance Pillar?
True or False: You can use the Epic Medical Record to search for a care team member's address when trying to have ice cream delivered to their house.
What is False?
This person might provide you with UM education in an official capacity.
Who is Kristi Beadle?
This field within the auth/cert section is where you would update a patient to "Approved as Inpatient".
What is UM Status?
This is sometimes offered by a payer once a denial has been issued (times may vary).
What is a peer-to-peer?
This committee develops an action plan for the Quality Pillar goal.
What is the Employee Engagement Committee?
This form, not to be confused with where Neil Armstrong was in 1969, is used to notify patient's that they are receiving observation services rather than being formally admitted as inpatient.
What is a MOON?
You might find this person volunteering at Marion County Animal Shelter on a Saturday.
Who is Julie Powell?
This type of authorization refers to the process by which an insurer approves a hospital stay or service classified under a diagnosis related group.
What is DRG authorization?
This is the role of physician, on the payer's side, who reviews cases that may be denied.
What is a peer reviewer or medical director?
This is the deadline for submitting 3 innovation ideas for the Innovation Pillar Goal.
What is October 31st?
This is the name of the process that is used when a hospital retrospectively changes a Medicare patient's status from inpatient to outpatient observation.
What is Condition Code 44?
This care team member resides in the Lonestar state.
Who is Jamia Sweet?
This is the official name for an authorization request started post discharge.
What is retro authorization?
This type of denial does not warrant a peer-to-peer review and does not result in the UM Status being updated to Denied.
What is a secondary payer denial?
This survey is issued annually by MUSC, and 100% participation could result in score of 5 for our People Pillar Goal.
What is the Employee Engagement Survey/People's Survey/Press Ganey Survey?
These two audits are completed by the Leadership team every month and announced during staff meetings.
What is CC44 and 1MN?
This care team member previously served 6 years in the Air Force as an Air Traffic Controller, but these days you are most likely to find her working on her needlepoint project.
Who is Amber Martin?
This is the official name of the reference number provided by Acentra/Kepro/Medicaid FF before the Q prefix authorization is administered.
What is the Case ID number?
UHC uses this term for when a service is denied because it doesn't meet medical necessity.
What is an adverse determination?
These are the names of the six pillars upon which our goals are based.
What are Service, Growth, People, Quality, Finance, and Innovation?
This billing indicator is applied when a patient is discharged under the wrong patient class.
What is self-audit or 353 type change (either answer will be accepted)?
This is Jennifer Thorpe's official title.
What is System Chief of Case Management, Post Acute Care, and Utilization Management?