E&E Questions
The amount of hours an employee working for a contractor (construction) need to work in order to be eligible for benefits.
140 hours
PHI
Protected Health Information
The name of the two character information that can keep a claim from being a duplicate and allow a processor to pay the claim.
Modifier
The amount of time that has to authorized for the compliance of a C-PAP.
3 Months
Ocular of tigris
Eye of the Tiger (by Survivor)
The amount of hours a non-bargaining employer has to report for an employee in order for the employee to be eligible for benefits.
160 Hours
ACA
Affordable Care Act
A duplicate edit is received on a claim with allowables and the duplicate claim shows a provider discount fee type on all lines.
Pay the claim
Enteral feeding, CT scans, partial hospitalization, radiation therapy, and dialysis. Which one does not require an authorization?
Dialysis
Expired in your Brachiums
(I Just) Died in your Arms (by Cutting Crew)
The type of members eligible for the UHC plan.
Medicare Eligible Retirees
AD and D
Accidental Death and Dismemberment
An inpatient claim has a 450 revenue code (ER) and no authorization.
Not pay
Does removal of wisdom teeth require an authorization and why or why not?
No, we do not cover removal of wisdom teeth.
Hyperphagia Oculars
Hungry Eyes (by Eric Carmen)
This is how a member working for a single employer, adds dependents to his/her plan.
Employee should contacts their employer.
EDI
Electronic Data Interchange
Claim has a diagnosis of O99.210 (obesity complicating pregnancy, unspecified trimester) for dependent other than spouse, pay or not pay the claim?
Not pay the claim
Does FMCP pay for Electric Shock Therapy if authorized?
Yes
Acetabulofemoral Joints no Falsehood
Hips Don't Lie (by Shakira)
A member's Special Fund Account contributor.
The employer only
COBRA
Consolidated Omnibus Budget Reconciliation Act
The claim has chemotherapy billed and the HCPCS J9217 and there is no authorization.
Pay your claim.
Neither chemotherapy or J9217 require an authorization.
Does E1390 require an authorization and what is it?
No, it is oxygen
Place your Cranium on my Glenohumeral Joint
Put your head on my Shoulder (by Paul Anka)