The CRS program provides a wide variety of
Managed Care services including Medical Eligibility, Prior
Authorization, Consultation Request, Utilization Review, Provider
Relations, Grievances and Claims Disputes.
Medical Eligibility
CRS managed care approves over 300 new member applications per
month. Each application is reviewed for appropriate medical and
enrollment information. Approved applicants are scheduled for a
medical appointment before the enrollment process can be complete.
To find out more about how to become a member, click on the link
below. How to become a CRS member
Prior Authorization
Managed Care receives and processes over 1,500 provider service
request (PSR) forms per month. Once processed the PSR form is
returned to the requesting provider via fax. Incomplete PSR forms
are returned for correct information. PSR requests submitted for
services outside the covered benefits are denied and returned to
the requester. Managed care medical staff pride themselves with the
timely and accurate processing of PSR requests. Copies of the PSR
form can be obtained from the forms link. Questions regarding PSR
processing can be referred to managed care through contact us
Consultation Request
Managed Care receives and processes approximately 300 consult
requests each month. Incomplete Consultation forms are
returned for correct information. Consultation requests submitted
for medically ineligible services are denied and returned to the
requester. Managed care medical staff prides themselves with timely
and accurate processing of consult requests. Copies of the consult
request form can be obtained from the forms link. Questions
regarding consult processing can be referred to managed care
through contact us
Concurrent Review
Staff in the managed care department follow all CRS patients
admitted for treatment in any of the CRS approved inpatient
facilities. The most actively used are St. Joseph’s, Phoenix
Children’s and Banner Desert. Utilization review staff
monitor patient care to verify the level of care continues to meet
CRS guidelines. The utilization review nursing staff also
coordinates care with other payers to help facilitate a smooth
transition on discharge.
Provider Relations
Provider Relations staff work closely with providers and group
practices. Their focus is contracting, office staff education and
acting as liaison between the provider and the CRS program. You may
reach Provider Relations through contact us
Grievance and Claims Disputes
Grievance and Claims dispute staff services are available to assist
provider staff with adverse decisions they believe were not made
correctly. The process for submitting a claims dispute or grievance
is outlined in the provider manual.
Last Updated July 1, 2007