Goal: Display tactful behavior when communicating with providers when communicating with medical providers regarding third party requirements. Show sensitivity when communicating with patients regarding third party requirements. Materials: Prior authorization form, patient medical chart with planned procedure and CPT code. Diagnosis for proof of medical necessity. Scenario: Patients preauthorization was denied because a second opinion is required. You must explain to the provider new policies from the insurance company requires a second opinion before they will approve the procedure. You will explain to the patient the new policy of their insurance carrier requiring a second opinion for corroboration of medical necessity before the procedure will be approved. Method: Step Number Procedure Points Possible Points Earned

1. Tactfully explain to the providers the insurance carriers new policy requiring a corroborating second opinion prior to approval for the procedure.

2. Demonstrate sensitivity explaining to the patient the necessity of a second opinion to corroborate the medical necessity of the procedure prior to approval