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Crossword Puzzle
Crossword Puzzle

Authorization Definition Game

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Authorization Definition Game

Crossword Puzzle

Activity used for the learners to gain knowledge on Inpatient and Outpatient Authorization terms.

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About Crossword Puzzle
Emotional education
1º Infantil
authorizations
0 times made

Created by

Kathleen Hart
Kathleen Hart
United States

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Crossword Puzzle

Authorization Definition GameOnline version

Activity used for the learners to gain knowledge on Inpatient and Outpatient Authorization terms.

by Kathleen Hart
1

Request for an authorization/claim is received after the service has been completed or is ongoing. For ongoing treatment (i.e. - month-to-month reviews - NPWT, specialty mattresses/beds), if the request is made after the start date of the next month's service(s); the request should be considered Retrospective/Post-Service

2

Request for authorization to receive in-network benefits for services provided by a non-network provider or facility

3

Post-Service - When the member has already been discharged and the notification date is after the discharge date

4

Request for authorization to receive in-network benefits for services provided by a non-network provider or facility.

5

A written or verbal request, made by a provider or a member, for: confirmation that the member has benefits for a requested service, and that reimbursement will be made according to the terms and provisions of the member's plan

6

Request for an initial inpatient stay when the member in the bed, or Request for a review for an extension of a previously approved, ongoing course of treatment

7

A request for an Expedited Review is necessary in situations were applying the standard time frame for deciding could seriously jeopardize the life, health, or safety of the member or others due to the member’s psychological state, or subject the member to adverse health consequences

8

Request for an authorization received in advance of performing the service

9

Process Author by Humana utilizes to ensure that a member's heath care is not disrupted when a member is currently under the care of a provider that has or will be terming with Author by Humana.

10

Request for authorization to continue an active course of treatment at the same level of coverage for a new member transitioning to Author by Humana or transitioning from one Author by Humana plan to another

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