ASSIGNMENT 5.5 OBTAIN AUTHORIZATION FOR CONSULTATION FROM A MANAGED CARE PLAN Performance Objective Task: Conditions: St

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Assignment 5 5 Obtain Authorization For Consultation From A Managed Care Plan Performance Objective Task Conditions St 1 (274.54 KiB) Viewed 17 times

Assignment 5 5 Obtain Authorization For Consultation From A Managed Care Plan Performance Objective Task Conditions St 2 (211.16 KiB) Viewed 17 times

ASSIGNMENT 5.5 OBTAIN AUTHORIZATION FOR CONSULTATION FROM A MANAGED CARE PLAN Performance Objective Task: Conditions: Standards: Complete a treatment authorization form to obtain permission for consultation for a patient from a managed care plan. Use a treatment authorization form (Fig. 5.5), computer, and printer. Time: minutes Accuracy: (Note: The time element and accuracy criteria may be given by your instructor.) Directions: Complete the treatment authorization form for this patient (see Fig. 5.5), date it September 3 of the current year, and submit it to the managed care plan. Refer to Fig. 5.2 in the Textbook for visual guidance. Scenario: Frederico Fellini, with a history of getting up four times during the night with a slow urinary stream, was seen by his primary care physician, Dr. Gerald Practon. An intravenous pyelogram yielded negative results except for distention of the urinary bladder. Physical examination of the prostate showed an enlargement. The preliminary diagnosis is benign prostatic hypertrophy (BPH). The patient will be referred to Dr. Douglas Lee, a urologist, for consultation (Level 4) and cystoscopy. Transurethral resection of the prostate is possible at a future date. Dr. Lee's address is 4300 Cyber Street, Woodland Hills, XY 12345, and his office telephone number is 555-675-3322. His National Provider Identifier (NPI) is 55026717XX. Dr. Practon's managed care contract is with PruCare, identification number PC C01402X, of which this patient is a member. Mr. Fellini lives at 476 Miner Street, Woodland Hills, XY 12345, and his telephone number is 555-679-0098. His PruCare plan identification number is VRG87655, effective January 1, 20xx. His birth date is May 24, 1944. After the instructor has returned your work to you, either make the necessary corrections and place your work in a three-ring notebook for future reference or, if you received a high score, place it in your portfolio for reference when applying for a job.
College Clinic 4567 Broad Avenue Woodland Hills, XY 12345-0001 Telephone No. (555) 487-8976 Fax No. (555) 487-8976 MANAGED CARE PLAN AUTHORIZATION REQUEST TO BE COMPLETED BY PRIMARY CARE PHYSICIAN OR OUTSIDE PROVIDER Patient Name Fredrico Fellini Sept. 03.2022 Male Female Birthdate_ epho Number Addess 476 miner xtreet Woodland Hills Lyotone Nunts may 24, 1944 Primary Care Physician Geraid Practon Referring Physician Dr. Gerald Praction NPI M2C01402x NPI MLCO 1402X -NPI 55026717 xx Referred to Dr. Douglas Lee Address 4300 Cyber Street Woodland Hills XV 1234 elephone No. 555 675 3322 Diagnosis Code Diagnosis Code Treatment Plan Authorization Requested for: Consult Only Treatment Only Consult/Procedure/Surgery Description:. Description: Diagnosis. Diagnosis. Procedure Code: Procedure Code: Place of Service Office Outpatient Inpatient Other Facility: Physician's Signature: pyright © 2020 Elsevier, Inc. All Rights Reserved. TO BE COMPLETED BY PRIMARY CARE PHYSICIAN PCP Recommendations: Date Eligibility Checked: TO BE COMPLETED BY UTILIZATION MANAGEMENT Authorized: Deferred: Effective Date: Auth. No:. Modified: Expiration Date:. Health Net Pacificare Secure Horizons Other Fig. 5.5 Member/Group No. Date • Consult/Treatment. Diagnostic Tests Number of Visits: Length of Stay: PCP Initials: Not Authorized Met Life Travelers Pru Care No. of Visits: 61 Chapter 5 The Blue Plans, Private Insurance, and Managed Care Plans