Provider Selection
This screen is used to perform a provider selection.
What is EPDB - 01
This RUMBA screen is used to do a PBG search.
What is EPDB - 09?
These are the first 2 things checked when you open a contract.
What are term dates AND Carve Outs
This product code is used for AET2 Claims?
What is MC?
This provider should be searched first during provider selection.
What is Servicing Provider ?
This is the minimum number of pieces of information needed to complete a provider search.
What is 5?
These three pieces of information are needed to perform a PBG search.
What is PIN - SUFFIX - DOS?
This rating system can not be used to reprice a professional claim in SCM.
What is Mcare?
This information (found in the detail screen) can be used on a surgery code to tell us what contract rate to use from SCM.
What is the grouper?
The POS can be found in these two locations on your claim.
Where is On the provider screen (top left)
On the repricer screen (on the line details - and above the lines on a live claim)
This is the minimum number of digits in the zip code needed to make a partial address match.
What is 2?
This step is performed if no PBG is found.
what is a manual PBG Search?
This is the amount you would reprice a line with 2 units and billing method FLAT rate $210.
What is $210?
This button is pressed to bring us to the detail tab that can tell us more information about the CPT code.
What is F4?
This line status is used for non par claims.
What is A3 128?
These are the next 2 steps performed in EPDB 01 BEFORE going to BAMR.
What is View flags and Network Verification?
These are the usable PBG types for PROF claims.
What is CNFS - CFCL - CSFS?
These notes should be checked for each CPT code/ rating system used for additional repricing information.
What is Financial Comments?
What is MPPO?
This line status is used when the pay method is DENY.
What is A2 3Z?
This is the order, or hierarchy, in which you do your provider search.
What is Servicing provider -> Billing Provider -> TIN Owner?
(or Individual -> Group -> TIN Owner)
This is used when there is no useable PBG even after a manual search.
What is By Report?
An MDAASC rating system tells us to use which repricing method?
What is Burgess repricer?
In addition to the CPT code, POS, Product code, and Rating System, what other two pieces of information need to be correct to find a rate?
What is zip code and DOS?
This line status is used to reject a claim when we do not have a useable anesthesia provider type.