Services
Miscellaneous
Benefits
Benefits II
what program
100
Hospital , Physician , surgery , and Miscellaneous
What is Medical Services
100
True or False? Supplies require a prescription or certificate of Medical necessity
What is false
100
When quoting benefits from the benefit grid , the information is from whose perspective is it ?
What is Member perspective
100
Service type for Bone Density Scan -Medicare Physician services
What is BINDSY
100
Where do I find SOB
What is Humana.com
200
Diabetes screening -Glucose test
What is Physician Services
200
Wheelchairs, Crutches, Oxygen Tanks and Canes
What is DME or Durable Medical equipment
200
When using CCP Benefit tab Detail sub tab to quote benefits, whose perspective is it
What is Humana
200
The percentage cap on what the provider can bill a Medicare member, If the provider does not accept Medicare assignment.
What is 15% above Medicare allowed amount
200
where do I find Coverage Issues
What is CCP Benefits tab
300
Emergency Room Facility Charge
What is Hospital Services
300
Amount physician submits for their services
What is total/billed Charges
300
contract/pbp # R5826-065 2016 MOOP IN/OON
What is 5100.00
300
Heather goes to a par provider for a service. provider total charge is $200 allowed amount is $170. the provider write off amount would be
What is $30
300
Where would I find the members claim information on a medication they filled last month
What is what is Rx Look /Rx Nova
400
Post-Operative care and stiches for a cut on the forehead
What is Surgical Services
400
Mr. Humana is going to his PCP the benefit is a $35 copay there is no ded or MOOP. if the PCP charge is $180 how much does the member pay
What is $35
400
what are the 6 steps of giving benefits
What is effective date, ded, copay , coinsurance , limits and moop
400
payment method usually associated with a HMO that has a contractually agreed upon rate usually expressed in per member per month
What is capitation
400
What is Taz's favorite program to get benefit information from, and what do we need from ccp to find the member's information?
What is EOC, what is contract. pbp and zip code,
500
Pathologist , Anesthesiologist , and Emergency Room Physician
What is PARE Provider
500
Period begins the day the member goes to a skilled nursing facility and ends when they receive no care for 60 days
What is Benefit Period
500
F,Y,K,AND 5
What is SPECIALIST PAR CODE
500
Mrs. Fields has a PPO that has a $500 deductible, and a IN/OON MOOP ,If she goes out OON provider and the Provider total charge is $200 what is the member's cost share?
What is $200
500
Name the programs that we can get benefit information
What is SOB, EOC, Coverage Issues, Benefits grid and ccp benefits tab detail sub tab.
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