for all members requiring a procedure or service or with an admission diagnosis on the targeted review list for the RN. All referrals... as well as targeted outpatient procedures, services and inpatient admissions. The activities will include telephonic review...
and routinely evaluate effectiveness of a streamlined process for TPE education, chart review, and accountability by engaging cross... for MAC review and promoting alignment across all key stakeholders. Establish clear guidelines that promote the consistent...