Disclaimers
PT,OT & Chiropractic
coverage based on medical necessity, must be restorative in nature, and excludes maintenance or preventive treatment
Article number that speaks to TAT
000016009
PT,OT,CHIRO & Acupuncture
Service Area Lookup Tool (SALT)
Denial Reason CID:212405455400
Member policy has been termed since 6/30/2021
Claim Adjustment
5-10 Business days from request date
Accumulation
Dollar amount and visits accrued are subjected to change based on claims paid at the time of this call
Article number that has queue names
000019380
Clinical Edits
Clear Claims Connection Tool (CCC Tool)
Reprocessed reason - CID :212413793700
Individual HCP is OON so claim was reprocessed under the group which is INN
Stop Pay/Reissue of Checks
15 calendar days from request date
Transfer
Please note you might be asked to repeat some information for verification purposes
Article number that speaks to third party payer accounts
000005430
Alliance Accounts
TPA Alerts
Why claim was reprocessed and paid less CID:211326885901
Initially was processed OON and priced by Multiplan then was reprocessed as INN and paid per provider contract rate
EOB Fax Request
1 business day
Choice Fund Accounts (HSA/HRA/FSA)
Customer has an additional fund designed to pick up customer responsibilities
Article number that speaks to claims timely filing
000013962/000011506
Mental health benefits
Behavioral health type of service classification excel
Reason claim was reprocessed thrice CID :211689544300
Initially was processed OON then reprocessed INN then was reprocessed for LPI to be paid to the provider
OON(Priced Claims) Clean/New Claim
30 business days
INN Benefits
Per contracted rate/Based on medical necessity
Article number that speaks to Evicore web portal
000044992
Provider Credentials
Provider Manager (HCPM)
Claim Status CID: 212530406100
Claim is over TAT and isn't pending for any information and should be routed to prepay to be finalized
Coverage Reviews/Discrepancies
30 Business days