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SE Region: Test your Knowledge

Select the states SE manages in ICUE? (select all that apply)
Mississippi (MS)
Tennessee (TN)
Georgia (GA)
Alabama (AL)
South Carolina (SC)
Virginia (VA)
Louisiana (LA)
Florida (FL)
North Carolina (NC)
West Virginia (WV)
Puerto Rico
Michigan (MI)
True or False: MS Medicaid (MSCAN) MH Crisis RTC (H0018) is built as IP in ICUE
True, IP using ICMR tab
False, OP using assessments tab
Provider calls looking for a prior-auth for an in-network IP SUD Detox (4.0) for Virginia Medicaid (VAMDN) member. How do we proceed?
Complete review in STAR
Complete review in ICUE
Tell provider it is not a covered benefit and quickly hang up
Refer provider to fax clinicals to the ARTS team
Ask provider to call back at a later time
Transfer to National IOP team
New phone, who dis?
In the state of Florida, an involuntary mental health IP admission is called what?
Marchman Act
Pink Sheet Act
MH Act of 1995
Baker Act
In the state of Florida, and involuntary SUD IP admission is called what?
Marchman Act
Pink Sheet Act
SUD Act of 1995
Baker Act
Provider calls seeking in-network IP MH authorization for TNCARE member in ICUE. How do we proceed?
Unplug your modem
Transfer back into SE queue
Send to dedicated team, SE does not manage
Complete auth in STAR as admission is INN
Complete auth in ICUE because it's TNCARE
Residential LOC is NOT a covered benefit for Florida Medicaid (FLMMA) unless.... (select all that apply)
Provider offers to venmo you
Member is 21 y/o or younger
Member is pregnant
Provider offers to complete your survey
It's a stand-alone facility with Medicaid contract line
It's a Baker Act Admission
Provider calls from an INN Mississippi facility looking for a PRTF prior-auth for a MS Medicaid (MSCAN) member age 16. How do we proceed?
Who is PRTF?
Complete review in STAR
Complete review in ICUE, built as IP; Place of Service: Residential
Complete review in ICUE, built as OP; Place of Service: Residential
INN FL provider calls in around noon requesting authorization for an involuntary FL Baker Act admission for a FLDSNP member. How do we proceed?
Complete in STAR, TAT is 30 minutes
Complete in STAR, assign to daytime CA via Sharepoint
Message all FL CA's informing of Baker Act admission
Complete in Linx as an FAI note
Which of the following Medicaid/DSNP plans do NOT go to Afterhours (6:00-7:00pm CDT)?
FLMMA | FLDSNP
VAMDN | VADSNP
LABYHP | LADSNP
NCMMC | NCDSNP
An OON Louisiana provider calls requesting a SCA for SUD RES 3.5 LOC. How do we proceed?
Complete review in STAR
Complete in ICUE, built as OP
Complete in ICUE, built as IP
What's a SCA?
Gather clinicals and add into a Case Contact Note
INN Louisiana provider calls seeking authorization for RES SUD ASAM 3.7 for Louisiana Medicaid member (LABYHP). What are your next steps?
Clarify if this is a 3.7co or a 3.7D, if INN program, move forward in STAR
Explain this is not a covered benefit
Treat as IP SUD Detox admission and move forward in ICUE, built as OP
Transfer back into the SE queue
How is Louisiana SUD LOC 3.7d (3.7WM) different from 3.7co? (select all that apply)
3.7d is residential detox | 3.7co is detox with poly-substance abuse
3.7d = H0011 | 3.7co = H2036
3.7d is residential detox | 3.7co is unrelated to substance abuse
3.7d is residential detox | 3.7co is residential where member must have BOTH SUD and MH diagnosis
INN Louisiana Provider calls for 3.1 LOC (Halfway House) for LABYHP member, how would we proceed?
Complete review in STAR
Complete review in ICUE, built as IP
Explain 3.1 is not a covered benefit
Cut your headset wire
True or False: SUD RTC & RTC Detox are not covered benefits for MSCAN, MSCHIP, or MSDSNP
True
False
Facility has a contract line for "Virginia Cardinal Care Caid"... would VAMDN be considered INN?
No
Yes
INN Louisiana provider calls for Crisis Stabilization (H0045) for LABYHP member, how do we proceed?
Complete review in STAR
Cut the wire to your headset
Complete review in Linx; FAI
Complete review in Linx; Case Contact Note
Complete review in ICUE; built as IP
Complete review in ICUE; built as OP
Louisiana provider calls requesting IP MH LOC at 8:33am CDT on 07/26/23. What is the Turnaround time?
Thursday 07/27/23, 11:59 PM CDT
Thursday 07/27/23, 8:33 AM CDT
Thursday 07/27/23, 6:00 PM CDT
Same Day Review
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