Jv Medicaremedicaid Jeopardy Template

Time factors	DME	Case Management	Medicare	Medicaid
100 What is two business days Medicaid Pre-D Standard Decision is due in what time frame based on the receipt of the request a)what is 48 hours b)what is two business days	100 What is when UPMC is secondary When do you need a primary denial prior to review	100 What is a PHR - Patient Health Review Needs to be completed to gather additional information about patient needs on initial patient contact or every 6 months	100 What is "If it wasn't documented it wasn't done" or "Make sure your note tells the story" A cardinal rule for nursing documentation	100 What is "False" if member is under 21 years of age, all denials will fall under Medical Necessity The RN will process an administrative denial for an 18 year old when something is requested that is not a covered item. True or False?
200 What is one How many attempts must be made to Medicaid members for denials	200 What is an LCD/NCD When a procedure code requires a prior AUTH for a Medicare case, documentation of a ______ is required	200 What is PGI - Problems, Goals and Interventions Needs to be deactivated prior to closing a case management case	200 What is three (3) How many outreach attempts must be made to obtain additional information (total)	200 What is MA Partial Approval The determination that is used when services or items are partially approved and partially denied
300 What is 72 hours Medicare - the amount of time given for a decision on an expedited request a) 3 days b) 72 hours	300 What is 14 days A DME case is pended for further information, when is a decision required	300 What is 2 call attempts on 2 different days at different times of day. How many call attempts should be made before closing a case	300 What is "An outreach call must be made to the member" It is day 14 and the decision has just been made, what must you do to notify the member?	300 What is True To be a true readmission - all 6 criteria must be met
400 What is 24 Medicaid Expedited Request - request for additional information must be done within _____ number of hours	400 What is Administrative Denial MC/SNP - RN is able to this for MC/SNP if the request is not a covered benefit	400 True If you have a UM case that is complicated, will have discharge needs or member has a chronic illness, you should refer to general case management TH UM bucket, T or F	400 What is provider, member, or member's representative Who can make a request on behalf of the member	400 What is "CO Letter Review" Letters- For Medicaid Denial letters - where is a letter reviewed and generated - name the worklist you will send it to
500 What is within one business day after requesting the additional information Medicare Acute How much time is allowed for a decision when additional Information is requested	500 What is annually Recurrent reauthorization cases need to be closed how often?	500 What is 2 Referrals from stratification should be called within 30 days of identification. All other referrals should be contacted as soon as possible but no later than ___business days of notification	500 What is "when the AOR is received" 72 hours for expedited and 14 calendar days for Standard What is the timeframe of when a case begins if an AOR is requested	500 What is "UPMC" Responsible for automatically generating the Approval letter for Medicaid LOB

JV Medicare/Medicaid

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