Suzette 😉
The process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization.
Credentialing
What are the counties included in Regence Blueshield (Washington) or Pink Counties?
Benton, Chelan, Franklin, Grant, Kittatas, Okanogan and Whitman.
What are the affiliate provider of Valley Medical Center?
WVMC - WA Valley Medical Center
WVNU - WA Valley Medical Center Non-Union Employee
WPPO - WA PPO Network - and an NWPR Prefix of either WVNU or WVP1
What are the plan names under Asante upcoming benefit document 2024
Asante PPO Health Plan
Asante HSA Savings Health Plan
Asante Classic Reimbursement Health Plan
Asante Flexible Workforce Health Plan (AFWHP)
How much is the maximum benefit paid per qualifying pregnancy allowing billed charges. Charges will apply to the deductible and out-of-pocket max. The baby must be enrolled in order to qualify for the adoption benefits. The benefit will be subject to the baby's benefits. The benefit will not be prorated across plans.
$4,000
TRUE OR FALSE Customer Service should not quote EAP/Mental Health benefits for Blomquist Hale even though they are available in the SPD. Requests for benefit information should be referred to the EAP. Mental Health and Chemical Dependency benefits
TRUE
They are listed as requiring preauthorization on the Regence Preauthorization List. Preauthorization is not required for U of U members.
CPT 75572 and 75574 (CTA of chest or heart)
TRUE OR FALSE CPT 89290 is subject to preauthorization requirement at The University of Utah Infertility and Andrology Services.
FALSE- Not subject to preauthorization
Regence handles all levels of appeal Except
Behavioral health and ABA therapy Answer
Important information that we need to obtain to verify providers network status.
Tax ID or address.
If an In area provider called for a non Regence policy, do we channel or not?
Channel
If an In area provider from WA called in for a Regence policy, what do we need to ask next?
County where the service will be rendered.
For Asuris,if a provider is unsure of their contract status, provider CSPs should refer the caller to MultiPlan to verify.What phone number shuld we provide?
(800) 546-3887
what services are included under Urgent Care for Asente (effective jan 1 2024)
general medicine
surgery
laboratory
x-ray
Provider Customer Service handles general inquiries and navigation support around initial onboarding and re-credentialing that can be resolved by using the information and tools available via this page, the provider website, SDS, and Availity.
True
For claims processing information, for areas in Yellow Counties, for Regence Washington, Oregon and Utah members, how will they process claims?
Claims always process as local claims. File claims to Regence.
For Valley Medical Center, how are we going to process preauthorization?
Follow standard process for checking preauthorization requirements.
Different levels of participation a provider may have.
Non-Contracted Provider Participating Provider Preferred Provider
Asuris and BridgeSpan are Blue Plans and are eligible for BlueCard.
False - Not Eligible
Channel/Finding a Contracted Provider What is the article number.
16582