Front

Can you send letters from Create Correspondence during an active call?

Back

False

Front

What company code applies to the DMHC Process?

Back

200C

Front

What must you do to complete the exempt grievance task if a member calls in looking for a claim that is not on file?

Back

Send the required letter.

Tags

CCSS.RI.11-12.4

CCSS.RI.7.4

CCSS.RI.8.4

CCSS.RI.9-10.4

CCSS.RI.9-10.4

Front

What is needed to complete your exempt grievance task if a member's Prior auth hasn't processed due to missing medical records?

Back

Send the required letter.

Tags

CCSS.RI.11-12.3

CCSS.RI.11-12.5

CCSS.RI.8.3

CCSS.RI.9-10.3

CCSS.RI.9-10.5

Front

If you are reviewing multiple claims and one is not on file, what must you do to complete the exempt grievance task correctly?

Back

Open a second Manage claims task to document claim not on file.

Front

What is the purpose of sending a required letter in grievance tasks?

Back

To formally communicate necessary information or decisions to the member.

Tags

CCSS.RI.11-12.3

CCSS.RI.11-12.5

CCSS.RI.8.3

CCSS.RI.9-10.3

CCSS.RI.9-10.5

Front

What does the term 'exempt grievance task' refer to?

Back

A task related to grievances that are exempt from standard processing rules.

Front

Why is it important to document claims that are not on file?

Back

To maintain accurate records and ensure proper follow-up actions.

Tags

CCSS.RI.11-12.3

CCSS.RI.11-12.5

CCSS.RI.8.3

CCSS.RI.9-10.3

CCSS.RI.9-10.5

Front

What is the role of the provider in the grievance process?

Back

To provide necessary information or documentation related to claims.

Front

What should you do if a member's claim is missing medical records?

Back

Notify the member and send the required letter.