ICE Training Benefit Summary
Pre-Existing
Benefit Maximums
Claim Status Codes
Terminology
100
Using the training benefit summary, this is the copay for medical sick office benefits.
What is $25
100
How long are members subject to the pre-existing exclusion period?
What is 365 days
100
Using the training benefit summary, this is the maximum number of skilled nursing visits allowed per lifetime
What is 81
100
This status code means a claim is open and has not been processed yet
What is O status
100
A CPT code describes what
What is the procedure that was performed
200
Using the training benefit summary, what is the out of network percentage for durable medical equipment?
What is 80%
200
Having this from a prior carrier could reduce or eliminate the amount of time a member is subject to the pre-existing exclusion period.
What is a certificate of credible coverage
200
Using the training benefit summary, we will initially allow how many physical therapy visits before requesting additional information
What is 12
200
This status code means a claim is in preprocessing and has not been entered into PowerSTEPP yet
What is X status
200
What does COB stand for
What is coordination of benefits
300
Using the medical training benefit summary, oral surgery coverage guidelines are found on this page
What is page 4
300
Any member under what age will not be subject to the pre-existing exclusion period
What is age 19
300
The maximum number of chiropractic visits allowed per calendar year
What is 25
300
This status code means a claim has been adjudicated and is waiting for the next check run
What is A status
300
What does PPO stand for
What is Preferred provider organization
400
Using the training benefit summary, benefits for routine medical exams are found on page
What is page 11
400
The look back period for the training benefit summary is how long
What is 180 days
400
The amount of visits we will allow for occupational therapy before requesting additional information
What is 12
400
This status code means the check run has taken place and the claim has been posted
What is P status
400
Describe an out of pocket maximum
What is the maximum amount a member will pay before claims are paid at 100%
500
Using the training benefit summary, in network outpatient psychiatric office visits are covered at what percentage after a $25 copay
What is 100%
500
In order for a member to recieve credit for any prior credible coverage, there must not be a break in coverage over how many days
What is 63 days
500
We will allow cardiac therapy services for how many months before requesting additional review
What is 3
500
This status code means an adjustment has been performed on a claim
What is C status
500
What does the term "product code" mean
What is whether a claim is medical, dental, vision.
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