On the SEIN screen, what does OCL: Y COB: N mean?, This member is not covered for health, This member has us as their primary insurance, The CSA needs to F1 on OCL to determine primary insurance, The CSA needs to F1 on COB to determine primary insurance, What do we need for a HIPAA check?, Member's Name, DOB, and ID number, Member's Name, DOB, and Tracking number, Subscriber's Name, Member's Date of Birth, and confirmation of relationship, Subscriber's Name, Subscriber's DOB, Member's Name, Member's DOB, Publix member, IP ER, Dx: U07.1, OPNR, CSA/Cohere Approvable, UM Review, Vendor, Observation under 48 hours, OPNR, CSA/Cohere Approvable, UM Review, Vendor, Beall's, Inc, IP ER, Leg chopped off syndrome, UM Review, OPNR, CSA/Cohere Approvable 5 days, Vendor, Maternity & NICU requests, Transfer to Maternity Nurse, OPNR, Transfer to Maternity CSA, Approve, Which provider field is not required to be filled out for IP ER and Rendering requests in Cohere?, Ordering Provider, Performing Provider, Performing Practice, Performing Facility, For PT-OT-ST requests, Cohere asks for the number of visits total it would be because it is checking for:, Medical Necessity, If the provider is lying, Primary vs Secondary, Exhausted Benefits, Choose the CSA Approvable DME:, Oxygen Codes on the EOC, CPAPs for A. Duda & Sons, Purchases under the Threshold, Rentals under the Threshold, Find the Home Health Code, G0238, L5010, S9131, J7030, IF the group has a Buy & Bill Vendor AND the Brand Name is on the Drug List, THEN:, It goes to the Buy & Bill Vendor, We send it over to a Pharmacy UM, Buy & Bill Vendors don't exist, they're all pharmacy, Approve the request, Publix, 70543, UM, CSA/Cohere Approvable, Vendor (Evolent), Vendor (Avalon), Women's Care, 27447, Accolade, Quantum, Evolent, Avalon, A. Duda & Sons, 81206, Accolade, Quantum, Evolent, Avalon, Publix, 27130, Accolade, Quantum, Evolent, Avalon, Group & Individual, 26508, OPNR, CSA/Cohere Approvable, Vendor, Pend to UM, The Chemo Wiki, Specialty Pharmacy, Outpatient Chemotherapy, OPNR Guide, Procedures Requiring, A. Duda & Sons, Hernia Repair, OPNR, CSA/Cohere Approvable, Vendor, Pend to UM, Publix, Hernia Repair, OPNR, CSA/Cohere Approvable, Vendor, Pend to UM, Do we back date for elective things?, NO! Tell them the post service information. If it is an ongoing service you can start it for the day we are contacted but no further back., NO! Tell them they are outta luck, Chuck!, NO! Hang up so they don't get a chance to respond!, Yeah, sure, no problem, If we have no disclosure form and no verbal consent, can we give just anybody information about a member as long as they have the name, DOB, and Member ID?, Yes, if they are the guardian and the child is over 18, Yes, if they are a close friend or relative and can prove it with facebook, Yes, but only if they yell at us about it., No, if they are not a covered entity or someone with a disclosure form or verbal consent, we cannot provide them with member information, How many requests can we handle in one call?, Just 1, Just 3, Unlimited, Redo full script, Unlimited, skip greeting and tailor recap to indicate that you know another request is coming., Which Status in Cohere means I need to do some additional research before providing my answer?, Pending, OPNR (Draft), Vendor (Draft), Approved, If I do not have my CAQ answers in Cohere, what should I do?, Assume, Select at Random, Ask my Caller, Skip w/o answering, My Inform Note looks like:, Who I spoke to, what they asked for, what I did about it, CPT Codes, DX Codes, Cohere Determination, Caller, Status, My First Name and Last Initial, The way the call came in, who you spoke to, who you transfered them to

Intro Final Knowledge Check

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