Confidentiality
The verification items needed when a member calls.
What is the member name, ID number, DOB, and address
The benefit for a ECG/EKG for a latitude member for 2021.
What is:
In-Network:
15% COINS OF THE PROVIDERS CONTRACTED RATE FOR DIAGNOSTIC IMAGING/THERAPEUTIC SERVICES WHEN ORDERED BY PCP OR SPECIALIST WITH WHOM THEY HAVE A REFERRAL AND PERFORMED AT A PAR FACILITY.
The part of Medicare that covers inpatient care.
What is Part A.
The PHP premium address to send check payments.
What is:
Members making payments by mail:
PO Box 4175
Portland, OR 97208
The network row we look for in facets to verify a provider is in-network for our plans.
What is MCAR.
The verification items needed when a provider calls.
What is the member name, ID number, DOB, and Address
The benefit for an in-network cardiologist office visit for a Dual Plus member for 2021.
What is:
In-Network:
OFFICE VISIT IS COVERED IN FULL, REFERRAL FROM THE PCP REQUIRED
IF OHP ELIG IS LOST, MBR WILL HAVE 20% COINS OF THE PROVIDERS CONTRACTED RATE.
*$203 PART B DEDUCTIBLE APPLIES
The part of Medicare which covers prescription drugs.
What is Part D.
An extra amount paid on top of plan premiums to social security based on high income.
What is D-IRMAA
The tool we use to tell a member in-network cardiologists near their home.
What is the provider directory.
The information we are not able to disclose to a provider.
What is
Disenrollment inquiry/reason for term
Premium inquiry
Social Security Number
The benefit for nutritional counseling for a Medicare Extra member for 2021.
What is:
In-Network:
SERVICES COVERED IN FULL. MUST BE ORDERED BY PCP OR SPECIALIST WITH WHOM THEY HAVE A REFERRAL AND PERFORMED BY AN IN NETWORK PROVIDER OR FACILITY. (SERVICES ARE NORMALLY PROVIDED ON AN OUT PATIENT BASIS)
Bonus: The coverage criteria:
Nutritional Counseling its covered regardless of diagnosis and covered as medically necessary (no limit on visits)
The part of Medicare which covers outpatient office visits, labs, and preventative care.
What is Part B.
The time frame when EFT payments come out of a members account each month.
What is the 15th-20th of the month.
The greeting when answering the phone.
The information that can be given to a conservator on file.
What is:
The benefit for a speech therapy for an Align member for 2021.
What is:
In-Network:
OUTPATIENT REHAB SERVICES ARE COVERED WITH A $20 COPAY FOR EACH VISIT, MUST BE ORDERED BY PCP OR SPECIALIST WITH WHOM THEY HAVE A REF AND PERFORMED AT A PARTICIPATING FACILITY, NO LIMIT ON VISITS
What is A and B.
A resource to help members who need extra help paying plan premiums and prescription costs.
What is Altergra, or the state Medicaid office, or Shiba.
The benefit disclaimer given when quoting any benefits.
What is
Please remember the benefit information provided in this call is just a brief summary, not a comprehensive description of benefits."
The length of time a verbal consent is good for.
What is the business day.
The benefit for allergy testing for a PHIP Align member for 2021.
What is:
In-Network:
LABS ARE COVERED IN FULL WHEN ORDERED BY PCP OR SPECIALIST WITH WHOM THEY HAVE A REFERRAL
AND PERFORMED AT A PAR FACILITY.
In-Network:
DIAGNOSTIC TESTS AND PROCEDURES ARE COVERED IN FULL WHEN ORDERED BY PCP OR SPECIALIST WITH WHOM THEY HAVE A REFERRAL AND PERFORMED AT A PAR FACILITY.
True or False: Members can have a Medicare Advantage plan from Providence and a Stand Alone Part D plan with another company.
What is False. Members cannot have a stand alone part D plan with a Medicare Advantage plan.
All of the ways a member can pay an individual bill.
What is by check, online recurring or one time payment, by phone recurring or one time payment, or by phone with membership accounting.
The tool providers use to see member benefits, claim status, coding policies, and updates from health plan.
What is Provlink.