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PSCCR | CIW WGS ACMP OMPTA

Total questions: 25

Worksheet time: 13mins

Name
Class
Date
1.

A wild card can be used with the search feature by typing three characters and a/an

a)

asterisk

b)

exclamation mark

c)

semi colon

d)

dash

2.

To create an authorization within ACMP, what should be clicked first

a)

Create Authorization

b)

Quick Links

c)

Global

d)

Pega CRM Application

3.

To transfer a case within ACMP, click

a)

Case summary, Clinical Review, Case Details

b)

Request Details, Case Details, Close Case

c)

Case Details, Request Details, Transfer Case

d)

Open request, Search, Clinical Huddle

4.

Enter the non clinical/clinical documentation in...

a)

Attachments

b)

Addendum

c)

Notification

d)

Notes

5.

What do you click in order to add more detail or edit to an existing note?

a)

Add and Save

b)

Append and Save

c)

Note and Save

d)

Notification and Save

6.

In sending a case to PCR, set the Status and Status Reason of the case as Pend ______

a)

For doctors review

b)

Denied

c)

Peer Clinical Review

d)

Partially met the criteria

7.

To add a medical record number click the...

a)

Alerts Pin Tab

b)

Fax Pin Tab

c)

Notifications Pin Tab

d)

Notes Pin Tab

8.

To add policy in the procedure code, which icon should I select

a)

dollar sign

b)

split icon

c)

pencil/edit icon

d)

copy icon

9.

When sending a case to the medical director, which two fields must be filled in the clinical review tab?

a)

Set Status and Set Status Reason

b)

Clinical Criteria and Criteria Number

c)

Type of Review and Reason for Review

d)

Procedure code and Diagnosis code

10.

To close the ACMP case which icon can be used?

a)
b)
c)
d)
11.

We can reopen closed cases in ACMP

a)

True

b)

False

12.

When reviewing inpatient request, dates of service is not important.

a)

True

b)

False

13.

Level of Care field can be found in...

a)

Letters Tab

b)

Case Summary Tab

c)

Clinical Review Tab

d)

Intake Review Tab

14.

Fields that have an asterisk are...

a)

Wild Cards

b)

Problems, but can be ignored

c)

Click to open

d)

Mandatory and must be filled in

15.

In accessing M360, we open it using the:

a)

Open quick links in ACMP --> Global --> M360

b)

Open using this link https://M360/elevance/um/dashboardHome#

c)

Open using knowledge library

d)

Open WGS --> GF 11 --> input s --> enter

16.

DME Stands for

a)

Durable Medical Equipment

b)

Defense Medical Exam

c)

Defense Medical Equipment

d)

Dummy Medical Equipment

17.

DNA stands for

a)

Digital Nurse Assistant

b)

Digit Nurse Assistant

c)

Durable Nursing Aid

d)

Daily Nurse Assistance

18.

In CIW, UM rules can be found under

a)

Claim Data --> Editing

b)

Claim Data -->No

c)

Claim Data --> GF 29

d)

Claim Data --> Review

19.

In CIW, comparable screen of CX pop up is

a)

Notes --> xTen

b)

Attachments --> Pricing

c)

Claim Data --> Claim Editing

d)

Limited Liability --> Claim Data

20.

To check for susp/deny in WGS, Click f1 to the procedure code then hit __

a)

F9

b)

F2

c)

F12

d)

F19

21.

To identify ASO or Fully Insured on WGS, go to GF 14 then type the option: __

a)

CC

b)

C1

c)

C2

d)

CA

22.

To check for UM rule in WGS, hit GF __

a)

21

b)

29

c)

28

d)

19

23.

In accessing ACMP Training Environment, username will be default as

a)

psccrclin1

b)

Domain ID

c)

Employee ID

d)

PSCCR

24.

To change your password in WGS, we can change it using __

a)

IT Service Connect

b)

My IT Profile

c)

WCF

d)

WGS

25.

If LL pop up did not fire on WGS screen, we can check the limited liability using GF

a)

9

b)

14

c)

23

d)

26