Mediblue Current Process used and how it affects appeals and denials
|
|
|
|
|
|
|
|
|
|
|
| |
| |
|
Clinical faxed to Manila, Phillipines
|
|
*Faxing Delays
*Failed Faxes
|
| |
|
|
|
|
|
|
|
|
|
| |
| |
|
Manila establishes case in system and scans initial clinical to acute team
|
| |
| |
|
|
|
|
|
|
|
|
|
| |
| |
|
Acute team review
|
| |
| |
|
|
|
|
|
|
|
|
|
| |
|
Denial for lack of medical necessity
|
|
Site of service denial
|
|
Approved
*Documentation supported medical necessity
*On CNS inpatient list
|
| |
|
|
|
|
|
|
|
|
|
| |
|
Additional clinical faxed or called in to acute team
|
| |
| |
| |
|
|
|
|
|
|
|
|
|
|
Approved
|
|
Upheld
|
|
Additional information not considered due to appeal initiation or communication breakdown
|
| |
| |
|
|
|
|
|
|
|
|
|
| |
|
Appeal
|
|
Appeal
|
| |
| |
|
|
|
|
|
|
|
|
|
|
Mediblue Current Process
More flowcharts
