Medicare
What tab in Facets can you review claim criteria for both Medicare and Medicaid?
Dual Line Data Tab
How many markets in Exchange?
4
In 7100 and 7700 what does the provider specialty have before it?
Dollar Sign $
what does the Acronym CTP stand for ?
Claims Test Pro
What is the naming convention for the Claims data worksheet?
This needs to start with CDW and then the CFG#. Following the CFG number you can add other verbiage to help keep your work organized
For Medicare, what agreement is always Primary and what agreement is always secondary?
Primary is Medicare and Secondary is Medicaid
What are the markets for Exchange?
NCEX, SCEX, DEEX, FLEX
When you see Per diem 1 and Per diem 2 in an agreement when can you find the rates
Transfer into provider rate table under Networkx tab in facets
What does the acronym COB stand for?
Coordination of Benefits
What is the naming convention for your Test Sheet ?
“CFG#_Your initials_ Test Sheet”
What does it mean when a member has a Aligned membership?
The member has both Medicare and Medicaid AKA Dual membership.
What is another way of identifying Exchange market?
XCH
When you get a global agreement in any LOB how do you know what agreements are included in the global agreement ?
Reach out to TL or manager of that region to get a list of agreements before you start testing .
What does Acronym SNF stand for ?
Skilled Nursing Facility
When your template does not work in access where can you find the template ?
There is a file under Becky's name in 0 drive where you can copy and paste the template for whatever region.
In REG MDC what Lines of Business fall under DSNP?
SCDS, DEDS, FLDS
What are the state names for each exchange market?
North Carolina, South Carolina, Florida, Delaware
If you get a WR and the agreement on the claim is differnt then the agreement in the WR what do you go by?
The agreement in the CCF
What does the Accronym PCA stand for ?
Processing Control Agent
When you are working on a new LOB where is most of the information for the plan?
One Note
In REG MDC what Lines of Business fall under MMP?
SCM1, MIM1
What claims require the providers to bill as if they are billing Medicare ?
SNF, IRF, Home Health, Hospice
What dates does 7700 and 7100 go by for a new agreement build?
Default Effective Dates
7100-1-1-2018
7700-1-1-21
What does acronym SLA stand for ?
Service Level Agreement
If you have to make changes to you CDW/Test Sheet after it leaves your milestone what do you need to do with your naming convention?
Add V2 or V3 whatever is needed.