Benefit Language
Do you use the pdf page number or document page number in your breadcrumbs?
PDF page number
What is your favorite Halloween candy?
Mine is maybe kit kats or reese's cups
If someone says "HSR number" what are they referring to?
The authorization number
What do we use ATS for?
Houses all incoming appeals, we work our appeals in ATS
What is the benefit grid used for?
What is the name of the villain in the movie “The Nightmare Before Christmas”?
What is the header name within the exclusions section where you often find the exclusion for services that are not medically necessary?
All Other Exclusions
Have you ever dressed up your pet in a costume?
My black cat Kiki has worn a couple costumes but she is a little champ about it
What is the suggested plan language for TMJ, TMD
Temporal Joint
TMJ
Reconstruction
Cosmetic
Medically Necessary
What exclusion and definitions are included in ALL "Med Nec Yes" cases?
Exclusion for services that are not medically necessary, definition of covered health services, definition of medically necessary.
When would you include the exclusion for services that are not medically necessary on your case?
All cases with the plan type "Med Nec Yes"
“Ghostface” is a killer from which movie franchise?
Scream.
What is Cirrus used for?
Eligibility and Claims for members on the Cirrus platform
Reconstructive
Cosmetic
Sclerotherapy
Medically Necessary
If your section name is on page 52 and your numbered exclusion is on page 53, would you include the section name in your breadcrumb?
No, breadcrumb would be pg 53 #
What is the most popular Halloween candy? (according to some article I saw on buzzfeed)
Reese's cup
What is the state law grid used for?
To determine if an AOR is required for OON providers for FI cases
What movie villain wears a red‑and‑green striped sweater?
Freddy Krueger
Is language required for infertility cases?
Yes
What exclusion and definition are included on ALL "Med Nec No" cases?
Exclusion for EIU and Definition for Unproven
What header will you often find the Cosmetic Exclusion under
Physical Appearance
Where do you locate benefit documents for UNET cases?
Doc360 > COC SPD data group
What is BTB/E&I Benefit Template used for?
Getting Benefit language for cases when you can't locate a benefit document within BEACH/Doc360
What is your favorite holiday (if you celebrate)
Mine is Halloween!!