Question
What are the Core Values?
Respect
Empowerment
Agility
Leadership
Two places in the Customer Service module where the pre cert vendor can be found
Summary of Benefits and Insurance card
When I am required an examiner will fax a form to the provider of service to initiate me.
MNR (medical necessity review)
What is the Medicaid timely filing deadline?
36 months/3 years
What is the Mission statement?
An independent TPA investing in People and Innovation to deliver expert-driven experiences with REAL results?
When a vision claim is received by email or mail we go here to obtain a DCN # and create/hand stage a new claim
Image only claims
I am the Director of Operations at Auxiant
Angie Cooling
What two remark codes must be used when coordinating with Medicaid?
MA / 36
What does REAL stand for?
Respect
Empowerment
Agility
Leadership
This is where to check if an assistant surgeon is allowed
Trilogy Handbook
This is the law that was passed in 2010 that mandated 100% coverage for in network preventative care
ACA or PPACA or Obamacare
What do the letters in the PEARH(S) rule stand for.
Pathology, Emergency, Anesthesiology, Radiology, Hospitalist
Hill
I am the vendor some members HAVE to go through for spine and joint procedures.
Edison
This maternity rule timeframe allows for what length of stay following delivery?
48/96 rule
In HI, in order to see remark code descriptions you use which key?
%
You can find employee lives, where ID cards are sent and other group information here
Transmittal
Name one of the two pre cert Vendors we have to warm transfer to.
Cigna or AIMM
MLR stands for _____
Medicare Like Rates