PRODUCT ID: B0TN0001
GROUP ID: TNONEX
What is the benefit for OP surgery done in the Office?
$0.00 Copay, 50% Coinsurance, Deductible applies
What tab in facets can we locate the Referrals?
UM History
Does CPT 90838 for the state of CO require an Authorization?
Prior Authorization not required
For the state of CO what is the TFL for 1st level of appeal?
180 days from the Remittance Date
PDAT stands for?
Provider Data Aggregation Tool
How many hours are covered for Maternity IP stay? Both Vaginal and CS delivery.
48 for vaginal and 96 for CS
This is where we go to check more information about the referral.
Prospective UM
What services can we create a retro-authorization?
HHC and DME services
It is called a takeback of a payment from the provider
Recoupment
This is called the allowable amount of a service.
Medical Fee Schedule
PRODUCT ID: RGTX0000
GROUP ID: TXONEX
What is the benefit for the Specialist Office Visit?
$60.00 Copay, 0% Coinsurance, Deductible does not apply
Give 1 or 2 qualification/s for a referral exception?
Any of these:
Where can we change the DOS on a pending authorization?
Services Tab
How do we compute COB payment?
UHC AA - OI Paid = UHC Paid amount
Fixed amount a member pays for a visit or prescription.
Copay
Where can we quote CPT 76977 with Dx Z82.62 when done in an OP Hospital?
Preventive Care Services
What states does not require any Referral for the year 2023
State of AL, KS, LA, MO, MS, NC, OK, and TN
For state of CO, what services can we create an authorization?
IP services for members that are head-on-bed/already admitted
Provider received a recovery letter from UHC. What is the address to send the refund check?
UnitedHealthcare Attn: Recovery Services
P.O. Box 740804 Atlanta, GA 30374-0800
It is expressed as a percentage on the amount paid by the member
Coinsurance
What platform can we use for Telehealth Behavioral? What is the phone number?
AMWELL (855) 635-1393
Member ID: 122136570
Is referral 801917803 valid for Dr. PHILLIPS, WHITNEY L. under Tax: 061786616? Explain.
No, because specialty does not match even if they are under the same Tax
What do you call an authorization for OON providers?
Gap Exception
It is a law that applies to Out-of-network health care professionals at in-network facilities.
No Surprise Act (NSA)
What accumulates to the OOP?
Copay, Deductible, and Coinsurance.