KMS
What is PHP01?
The two places online you can find the Prior Authorization Request Form.
What is Provlink and the PHP External Website.
What is the benefit for Individual plans for tubal ligation in network ?
What is "Covered in Full"?
Did this claim deny 191694951800 and if so what would we tell the member?
What is: Claim processed due to a referral violation. No referral on file . Edu mbr that they can contact medical home to get a retro referral.
Where would a Cigna provider send in a PA for Physical Therapy
What is the Cigna provider would send it to ASH
The steps a member takes to find where they can shop for insurance.
What are: PHP Internet - I need an individual or family plan.
What is the In network hearing aid benefit for mbr # 100817291-00 Rebecca Lucas?
What is:
DME: 1000 DED 20 Coins 2500 OOPM
Limit: One per ear every 3 calendar years.
What fax # would the provider send chart notes on claim # 190575004000 to see if claim can be reprocessed.
What is: fax CE inquiry directly to Healthcare Services at (503) 574-8179.
TRUE OR FALSE. A First Health provider can bill the member for a PA violation
What is TRUE
The steps a member takes to find the member reimbursement form to fill out and submit to PHP.
What are: PHP Internet - Individual and Families - member forms and documents- claims - medical claim form
The in network benefit quote for HCPC code L3000 for MBR ID 100510120-00 and what location code is this covered at?
What is:
DED waived 10 Coins 1200 OOPM
limited to 200 per cyr
Covered at all locations
The reason why CL 200024417800 denied and did it deny to the member or the provider?
What is: No EIM PA on file
Denied to provider
How many office visits per approved for mbr # 113121805-00 Kthleen Fisher to see Dr. Depasse and have any been used
What is 15 office visits approved and 0/15 used
The provider relations rep responsible for Crook County.
Who is Robin Solomon?
The steps you take to get to the medical policies on Provlink.
The maternity in-network benefit quote for MBR ID 100169353-01 for a baby girl.
What are:
Prenatal Visits: CIF, DED waived
Delivery/Postnatal Visits,Inpatient Hospital/Facility Services, Routine Newborn Nursery Care:
1000 ded 20 coins 7350 oopm
The reason why CL 190994766800 denied and what would we tell the provider.
What is: u16 non-specific ICD-10 codes not accepted. Would need to send in a corrected claim changing the ICD-10 code.
Where would an our of network DME provider send in the PA request too and what is the fax #?
What is Health Care Services (HCS) and the Fax # is 503-574-6464
The Timely Filing Requirement for an initial submission on a claim.
*BONUS: What is the timely filing requirement for a corrected claim for Oregon-based plans?
What is 12 months from the DOS?
*BONUS: What is 18 months from the processed date?
True or False: A provider can edit a referral via provlink
What is: True
The acupuncture benefit quote for MBR ID 10059503500 to see Amanda Real on Milwaukie Ave, Portland OR and do they need a referral
What is:
Acupuncture-Combined with Chiro . 15 Copay and a 500 cyr benefit
Alt Care OV-ded wvd 15 copay 3500OOPM
Xrays/Labs-ded wvd 20 coins 3500 OOPM
Outpatient Rehab-ded wvd 20 coins 3500 OOPM combined with PT/OT/ST limited to 30 visits per cyr
No referral req
The reason why CL 203004195400 denied and what would be the next steps
What is: Referral on file. Claim should be sent in to be reprocessed
For mbr # 100178385-00 Lisa Carr what is the DOS that she used the referral # 193640328 for Dr. Reddy or a covering provider.
What is: DOS 1-17-20. Covering provider Dr. Blattler