Instructor-led module
This is a teacher-driven module — your educator leads the session and moves the group along this path in order: the pre-assessment first, the three guided lessons, then the graded assessment and evaluation. The checklist and policy lookup are job aids you can return to any time, during and after the session.
How the module is scored
Each objective is mastered at 80% — at least 4 of 5 case-based scenarios for Objectives 1 and 2, and at least 80% of required steps on the structured checklist for Objective 3. Course effectiveness is also judged on whether the group mean post-assessment score exceeds the group mean pre-assessment score, so take the pre-assessment before Lesson 1.
Training path
Five case-based high-dollar claim scenarios taken before instruction. Your score is the baseline for the before/after comparison — answer from what you know today.
Learn where implant information lives in a claim and the cues that signal a service needs additional medical-policy review.
Practice locating the applicable medical policy, reading its coverage sections, and connecting claim facts to policy language.
Work the complete review process end to end on a simulated high-dollar claim: verify, check current policy, document, escalate, and avoid common errors.
Five graded high-dollar claims you work independently. Scored against the 80% mastery goal across all three objectives.
Interactive, autosaving eight-step checklist — use it while you work the assessment. Download or save as PDF when done.
Nurse-friendly list of every Blue Cross NC policy by implant type, with the key determination rule and a link to the live policy page.
Anonymous post-course Likert survey — clarity, relevance, usefulness, confidence, and readiness, plus one open-ended item.
The complete APA reference list for the module, every entry with a working link and a one-click PDF download.
Objectives at a glance
Objective 1
Following the educational intervention, participating nurses will identify implant-related information that requires investigational/experimental review in at least 4 of 5 case-based high-dollar claim scenarios (80% accuracy). Learners who do not reach the 80% benchmark will review the investigational-implant workflow job aid, receive targeted feedback, and complete an additional practice scenario before reassessment.
Objective 2
Following the educational intervention, participating nurses will apply the appropriate medical-policy resource to determine the investigational/experimental status of an implant in at least 4 of 5 case-based high-dollar claim scenarios (80% accuracy). Learners who do not reach the 80% benchmark will review the policy-search and application steps, receive targeted feedback, and complete an additional guided case before reassessment.
Objective 3
Following the educational intervention, participating nurses will demonstrate the investigational-implant review workflow by correctly completing at least 80% of required steps on a structured checklist while reviewing one simulated high-dollar claim. Learners who do not reach the 80% benchmark will receive targeted feedback, review the workflow job aid, complete an additional practice case, and repeat the performance assessment.
The eight-step checklist
Objective 3 is scored against this structured checklist. Use the interactive version while you work the assessment — it autosaves and exports to PDF.
Open the interactive checklistSession time & sequence
Your educator sets the pace and works the lessons in order — each builds on the last. Plan on roughly 20–25 minutes of guided instruction per lesson, plus about 20 minutes for the assessment and 5–10 minutes for the evaluation. The session runs about 90 minutes total, not counting the pre-assessment. The checklist and policy lookup pages are job aids — bookmark them and return any time after the session.