Team 1
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Team 2
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Teams
Name
Score
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15
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When you look in the RADS tool or benefits, if something is Limited, does it need an auth/referral?
Yes. It MAY be covered with an auth/referral if it shows as limited.
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Okay!
Check
15
×
True or False: EOPs go to the Provider
True: Explanation of Payment
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15
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What is a referral?
When PCM/provider places a request to send a member to a specialist
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trap
No points!
Oops!
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rocket
Go to first place!
Okay!
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fairy
Take points!
5
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15
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25
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banana
Go to last place!
Oops!
15
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True or False: Referrals do not have an end/void date.
False: Episode of Care: âĒ6 months for ADSM âĒ365 days for Everyone Else
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Okay!
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15
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What Reports Eligibility?
DEERS
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15
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How many visits is an Evaluate and Treat referral?
6 - 1 initial visit and 5 follow up visits
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15
×
When you look in the RADS tool or benefits, if something is Not Covered, does it need an Auth/Referral?
No, if it is not covered, we do not cover it at all/it may be on the exclusions list.
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Okay!
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monster
Reset all scores!
Oops!
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magnet
Take 25 points!
Okay!
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shark
Other team loses 5 points!
Okay!
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thief
Give points!
5
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25
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lifesaver
Give 20 points!
Oops!
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fairy
Take points!
5
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15
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25
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shark
Other team loses 25 points!
Okay!
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thief
Give points!
5
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25
15
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When you look in the RADS tool or benefits, if something is Covered, does it need an Auth/Referral?
No. It is covered and does not need any extra steps
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Okay!
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15
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Who determines Eligibility?
BOS: Branch of Service
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15
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What is an ICD-10 code?
Diagnosis code - a code for a symptom or 'diagnosis' a patient had.
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15
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How many Visits is a Second Opinion referral?
2 - 1 initial and 1 follow up
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Okay!
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15
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True Or False: DHA-QL covers LOD claims/Auths/Referrals
False: DHA- GL as in Defense Health Agency - Great Lakes
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Okay!
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15
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What is an Authorization?
when a PCM/Provider places a request to complete a service/provide DME for a member
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