Benefits
Members plan has an effective and termination date
What is an inactive (non-eligible member)?
Give you medical claims information in Facets
What is the medial claims tab?
Enter this on the front end of Facets to locate a member.
Subscriber ID
Gives office visits and wellness visit information
What is the Office Visit section?
Provider cannot verify the members DOB or address
What is no information can be provided?
Explains services performed by the provider. Consists of 5 digits
What is the CPT code?
Provider does not have the members subscriber ID. I can help you locate a member.
What is the Medicaid ID number?
Gives benefit information for SNF (skilled nursing facility)
What is the SNF of the benefit summary?
Facets shows a termed plan for the member. Provider says the member is active. The member has a plan in the state of MS
What is a Macess route?
Remove for best practices when researching a claim
What is the provider ID?
Provider NPI or tax ID cannot be located.
What is Dental, Pharmacy or an OON Provider?
Shows if the member has coverage for a wheelchair
What is the DME section of the benefit summary?
CPT code 99213 does not require and authorization
What is "I show that the CPT/HCPCS code(s) do not have prior authorization requirements. This does not guarantee coverage. Services are only payable if covered by the health plan and medically necessary?
What is a diagnosis code?
This should always be obtained from the provider during the opening of a call
What is Providers the providers name and call back number?
Gives coverage breakdown for contraceptives and sterilization
What is the family planning section of the benefit summary?
Shows authorization requirements for behavioral health services?
What is EPAL, behavioral health sharepoint?
What is the COB tab?
Take these steps to enter a provider's tax ID number
What is provider ID, search for ID, double click Name, Address, EIN?
Gives PT, OT and/or speech therapy benefit details
What is the rehabilitation section of the benefit summary?