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This is what happens if a Choice/Connect member were to see a primary care physician while travelling in Arizona.
What is: The claim would process out-of-network.
True or false: An Idaho resident can apply for an individual plan with Providence Health Plans.
What is false?
The dates in which it is considered "flu season".
What is 09/01 - 04/30?
Whether or not all commercial plans are self or fully funded.
What is fully funded?
BONUS: What does that mean?
The reason why CL 183515756900 denied.
What is not a covered benefit?
BONUS Bragging Points: Whose responsibility does it fall to?
True or false: Washington residents can apply for an individual plan with Providence Health Plans.
What is true? Open enrollment is underway for 2020 and Providence will be offering both OR Indi and WA Indi plans.
Whether or not Evergreen Prosthetics and Orthotics (Oregon City) is in-network or out-of-network for MBR ID 100105538-00.
What is yes? (Providence Home Services subcontractor)
The age in which a woman can obtain a DEXA scan and have it be CIF in-network due to the reform.
What is 60?
The timely filing for an initial claim submission.
What is 12 months from the date of service?
POS 81 is for this location.
What is a lab?
The department responsible for configuring Facets with pricing, benefits and provider information.
Who is Systems Admin?
Whether or not an individual member can obtain code E2326 from a provider's office or not.
What is no?
The place that information on benefits for traveling abroad are located.
What is the International Services topic?
Whether or not QFC is a preferred pharmacy for any PHP plan.
What is yes?
Whether or not MBR ID 100246056-00 has routine vision benefits.
What is no? (Rider is grayed out)
The labs that are considered preventive for adults and therefore CIF for member's on a non-grandfathered plan who have adopted PPACA.
What are: Cholesterol Screening, Diabetes Screening, Hep C Virus Screening (for adults born between 1945-1965), HIV Screening and Counseling, and Syphilis Screening.
Hospital type of bill code 117 is for this.
What is Hospital - Inpatient - Replacement of prior claim?
The number of different medications injected into MBR ID 100233378-01 for DOS 02/20/18 with Dr. Anna Macasa.
What are 2? (2 J codes were billed)
The modifier that a provider bills to indicate that a colonoscopy started out preventive, but turned diagnostic.
What is modifier 33?
When quoting surgery benefits, this is one thing we always *ALWAYS* ask for in order to check if a certain something may be required.
What is the CPT code?
Whether or not Dr. James Beckerman can be a covering provider for Dr. Roxana Abbott or not.
*Use MBR ID 113151169-01 for Facets lookup.
What is no? Provider specialties do not match.
Dr. Beckerman is a cardiologist. Dr. Abbott is family practice.
Whether or not a PA is required for something on the focal group list (requiring PA) if PHP is secondary for the member, and their primary insurance does not require a PA for the service.
What is no? (We follow suit with what the primary insurance requires or does not require)
The correction made to claim for MBR ID 100934355-00 for DOS 03/05/18.
What is: Provider changed and corrected the CPT code?
The fax # where a non-participating provider would submit a clinical edit appeal.
What is 503-574-8146?
Tiffany from Dr. Seth Stankus' office/TIN 911939739 (J Street) is calling to find out where she can mail and/or fax her claim to for MBR ID 113343236-00.
Where is FCHN - PO Box 2289 Seattle, WA 98111 and/or 206-268-6181?