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PEGACSA72V1 · Question #7

Before a member is admitted to a hospital, a health care organization reviews authorization requests for insurance coverage. An intake operator performs the Review Authorization Request assignment…

The correct answer is A. Add an SLA to the Review Treatment assignment that includes an escalation. See the full explanation below for the reasoning.

Question

Before a member is admitted to a hospital, a health care organization reviews authorization requests for insurance coverage. An intake operator performs the Review Authorization Request assignment to determine if the member qualifies for coverage. If the member qualifies for coverage, the case advances to the Review Treatment assignment for review by a physician. When the case arrives in the physician’s worklist, the system automatically sends the physician an email. If the member is denied coverage, the system resolves the request. The system also notification. How would you configure the process so that the system automatically sends an email to the physician when the case arrives at the physician’s worklist?

Options

  • AAdd an SLA to the Review Treatment assignment that includes an escalation
  • BAdd a notification to the Review Authorization Request assignment.
  • CAdd a notification to the Review Treatment assignment.
  • DAdd a SendCorrespondence local action to the Review Authorization Request

How the community answered

(37 responses)
  • A
    78% (29)
  • B
    11% (4)
  • C
    3% (1)
  • D
    8% (3)

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Full PEGACSA72V1 Practice