Name 2 resources available that outlines WMDS process
What is WMDS Quick Tips, Knowledge Library, ePST
200
The 2 buttons that needs to be completed/populated on tab 4
What is New Review and Reviewed Services
200
After clicking New Review, it is the reason to select on the Review Reason Selection window
What is CRITDN/ Does Not Meet Criteria or Guidelines
200
The button on Tab 2 Services that allows the user to set the same status for multiple services
What is Set Status on All
200
The line on tab 3, where the TAT are populated
What is the Request Line (Initial or Extension)
200
The template to complete when notifiying appropriate parties of a denial
What is the Denial Notification Template
300
The profile code for Home Care
What is HHRN
300
The place of service to choose for additional services on tab 2 for multiple surgeries
What is Hospital IP Additional Procedure
300
The reason to use on the Initial Request line if the member is already in the hospital
What is Concurrent Review
300
The UDW that allows the user to suppress letters
What is Case Service UDW
300
The reason to use for a case denied due to LOI
What is Insufficient Medical Information
400
The Tab where you can verify if letters were generated
What is Tab 6
400
The reason to use when pending a case that is being sent to the medical director
What is Requires Medical Review
400
The Reimbursement type to choose on Tab 1 Status folder for inpatient hospital cases
What is Non-DRG
400
It is what the nurse uses to document the Verbal Notice date and time
What is the medical necessity note that supports the nurse providing notification regarding the determination
400
Per the Adverse Determination Desktop, it is what the nurse needs to do after required attempts to obtain clinical information has been made and yet failed.
What is Round with MD and complete Rounding template. (one part answer is acceptable)
500
WMDS stands for
What is WellPoint Medical Decision System (WMDS)
500
The application you first log into when you want to access WMDS
What is Citrix or WellPoint or Anthem Citrix
500
The difference between managing ECC vs WMDS passwords
What is WMDS password needs to be manually changed
500
This is where you will find the member's address, phone number and gender
What is Member Details folder or Member Widget
500
It is where note templates such as MD Rounding template and Denial Notification Notes are accessed