SC REVIEW 2.0

When Completing a pre-certification search, there are several fields you can search by under Additional Options. Which option gives you a description of a disease or illness?

• Provider Specialty

• Diagnosis Code

• Benefit

• Physician and Medical Service

A provider calls on behalf of the member that wants to file a Grievance and Appeals. What information would you share?

• Nothing

• Submit grievance and appeal for member

• Submit grievance and or appeals in writing.

• Transfer to Grievance and Appeals CSR

You are ready to begin working on service requests. By clicking this, you will get the oldest and most urgent items first.

• Refresh

• My Worklist

• My Recent Workbasket

• Get Most Urgent

A provider indicates that she is also waiting for someone to call her back regarding another issue. Where can you view other promised actions for this provider?

• View the Interaction tab of the composite screen

• View the My worklist

• Click Get Most Urgent

Which of the following Search Inventory types can you search for? (Select all that apply)

• Interactions

• Other Actions

• Inquiry Tracking

• Service Requests