Referrals | Baamboozle - Baamboozle | The Most Fun Classroom Games!

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How do we remove a refferal from the system?

Satisfy the original referral on file to remove it from the system.

What two types of procedures that cannot be considered an "emergency"?

Orthodontics and Periodontics

If a member wants to change specialist office on referral, what are your next steps?

Create a new referral with member's preferred office.

When would we add to the sticky notes?

When approving D9310, D0150 or D8660

Before you begin the referrals what is the first thing the MSR needs to check?

MBR history to confirm if referral is in the system.

If benefit limitation was met, what must the agent do to rectify the situation?

limitation override must be applied to allow and/or pay for the services requested.

Are pre-estimates a guarantee of payment?

No

What PEC code is used when approving treatment procedures?

AG-20

How do you extend an appointment?

Custom Attributes, scrool to extend, add days member needs extended, and save.

True or False: agents should always verify if a referral is requirement on member plan

True

What specailty services qualify for emergecy referalls?

Endodontics, Oral Surgery and Pedodontics

What should be written in Remarks tab?

Reason for referral

What are the steps to satisfy a referral?

Custom Attributes- change referral to "satisfied" add date of call, and save.

What two specialist services are not covered for ER referral?

Orthodontics and Periodontics

What items do we need to verify on member's account before creating a Prior Auth

check benefits, limitations, and general claim guidelines. For pediatric, verify age limitations.

What codes do we use for consultations?

D9310, D0150

After you satisfy the original referral, what is your next step?

Create a new referral with the caller's preferred office location.

For oral surgery what cannnot be approved over hte phone?

supernumerary teeth

If an extension is beyond the 120 days, would a new referral need to be submitted?

Yes.

How do you add a line in Meditrac to add codes?

Blue +

Who can change to request office on referrals?

Confirm the member or authorized party is making the request. Providers cannot request office changes.

If a caution sign appears on the Action Code button bar, what are your next steps?

Check "apply overrides," then click the lightning bolt

When a referral is extended what must you advised the caller?

"The extension time frame is XXX, you will not receive a new EOB"

How do you advise a Referral is and emergency in Meditrac?

check mark the emergency box

What box do you check to indicate an Emergency referral?

Emergency box in Medtrac

True or False: a provider can submit an office request change on a referral?

FASLE