Just for Money...Scavenger Hunt

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Across
  1. 1. Not covered by the plan
  2. 6. Who you contact if provider wants to change date on auth
  3. 7. Tells what is wrong with the member and why they need the procedure
  4. 8. Who you ask if chat support is not available BEFORE asking CL Chat?
  5. 9. Providers can do this if a Jcode is not on a lockout list
  6. 12. Who you ask first before consulting Cl Chat?
  7. 14. 4 Mins Max without checking back
  8. 17. Button you hit on an auth to add additional units or visits
  9. 18. List you check after lockout list for Jcodes (if not on lockout list)
  10. 20. Ext 19194
  11. 21. When a Jcode is on the lockout list, who do you transfer to?
  12. 23. Call Group Pod 17 is part of
  13. 24. default date on an auth for diagnostic procedures
  14. 25. 2-3 days is standard, 3-4 delayed time
  15. 26. Employer who allows members to get their own referrals for a specialist (Provider cannot get these)
  16. 27. Can only be done after an auth has denied
  17. 28. "30 visits PCY" is an example of this
Down
  1. 2. 866-494-4507
  2. 3. These must be on file before requesting urgent review
  3. 4. This group handles special employer groups such as Sutter, CHS MYLIFE, etc
  4. 5. Report needed if a claim denies cause of injury.
  5. 7. On a surgery auth, this is what you put on the "To(Date" line when date is known
  6. 10. This TPA can take up to 45-60 days to process a claim
  7. 11. When you see 12-31-31 this is a ___________
  8. 13. Where you will check for information when a group terms
  9. 15. Form sent to members only stating that a provider has permission to dispute a claim on their claim
  10. 16. Can be used in place of Date of Birth for PHI
  11. 19. Always check here when giving a jcode
  12. 22. Whst should be done if a member has an acute or chronic condition (after checking to make sure one is not already made
  13. 27. Who you refer to is a drug is administered orally or is a self injectable
  14. 29. Statement given after a reason for the call has been given