Assessment
Reviewing Provider Program Integrity
Users will initiate Provider PI case process, and then review and decisions regarding providers based upon varying scenarios.
Tracking and Reviewing Non-Medicare Members
Track members identified within Audit Studio who are eligible, but not enrolled in Medicare with the purpose to communicate this information to DWS.
Processing Provider Training Plan
A trainer creates and completes the provider training plan with the relevant training details.
Criteria Review
In this module you will learn the steps involved in processing a criteria review for a state user
Committee Review
In this module you will learn how to complete the:
Case information form
Committee meeting
Assistant bureau director review
bureau director review
assistant division director review
special pricing
reference file update
Prior Authorization Internal Audit
In this module you will learn how to:
Create a PA internal audit
Process additional PA audit review
Process the complete training action
PRocess the review completed task
Introduction PA Internal Audit
Introduction Prior Authorization Internal Audit