UM Foundations

Front

Commercial Compliance Program standards have been established by? Options: Elevance Health Policies, Federal, state, and local laws, Contract obligations, All of the above

Back

All of the above

Front

T/F - Employees get bonuses based on the amount of denials

Back

False

Front

TAT stands for?

Back

Turn around time

Front

Some states require nurses/MDs to be licensed in their state prior to working UM. This is referred to as?

Back

SSL

Front

T/F - AUMSI is a wholly owned subsidiary of Elevance Health, it is designated to perform CASE management on behalf of Elevance Health

Back

False

Front

AUMSI program description includes: Regulatory Compliance, Accreditation requirements for NCQA, Quality improvement for UM.

Back

All of the above

Front

A decision to NOT approve a requested service, procedure, or length of stay is considered?

Back

Adverse Determination

Front

A UM case that is planned/scheduled ahead of time is known as?

Back

Elective

Front

T/F - PSCCR and PCR are the same thing

Back

False

Front

Doctors are referred to as

Back

Medical Directors, Physician Reviewers, Peer Clinician Reviewers, All of the above