PST week 1 quiz

What are the main HIPPA verifiers for providers?

• NPI

  complete name

  complete address

• NPI, SSN, Tax ID

• Complete name, complete address, SSN

What will be the level of service and review type for Inp surgery?

• Emergency

  preservice

• Elective

  continued stay

• Emergency

  continued stay

• Elective

  preservice

In what state can the patient be held for 23 hours before we can consider his/her an inpatient?

How many hours can a hospital put the patient on hold in Colorado/Nevada?

Tools use to check member's eligibility and benefits?

What do we use in checking Predetermination?

• Prior auth list

• Group profile

• Ompta

• Blue matrix

What are the main HIPPA verifiers for member?

• Member ID

  Member SSN

  DOB

• Member SSN

  DOB

  Complete name

• Member ID

  Complete name

  DOB

• Complete name

  Member SSN

  Complete address

A type of request that follows 48/96 hours mandate.

Handles more complex Medical conditions?

• Long term acute care

• Skilled nursing facility

• Acute rehab

Requires less doctor's supervision.

• Long term acute care

• Skilled nursing facility

• Acute rehab