Clark County
Ineligible
CFR reference Sheet
BN code guide
find the Hpdb Tab
100

True Or False

When an employee hits age 65 they MUST apply for medicare.

True

100

905

905-Charge(s) denied. Claim filing exceeded timely filing requirements for the contract. Provider may not bill you for this amount.

100

whats onbase fax number

855-444-2896

100

7K

Amount of Optum Health Behavioral claims only applied to combined deductible

100

Blood Pressure Cuffs/ Monitors

on 'Covered/ Excluded Services'

200

MID 354000605051 

What is the members Tier 2 Ded? What services does it apply to?

$250--Deductible is waived for most Tier 2 physician charges.**The following physician services will apply the in-network calendar year deductible of $250.00: Acupuncture, chemotherapy, Chiropractic Care, Home Health Care, Hospice Care Services, Orthotics, Prosthetics and TMJ Benefits.

200

what needs done for codes 368 & 369.

This is a CES edit which needs appeals with medical records.

200

Post-Service Appeals Address:

UMR Claim Appeals Unit PO Box 30546 Salt Lake City, UT 84130

200

PN

Skilled nursing max

200

Custodial care

Covered/Excluded Services – Custodial Care

300

Mid 354000607834  member Kayla 

Has her inv tier 2 ded been met? if not, how much of her inv tier 2 ded has been met?

$250 ded met

300

005

005-Charge(s) denied. Need Medicare Explanation of Benefits. If necessary, request new copy from Medicare and send for consideration.

300

other language Transfer (not spanish)

1-844-350-6774

300

RK

Deductible

300

Outpatient birthing centers

Pregnancy

400

What are 2 reasons a PPO plan needs to fill out COB form?

-Spouse is self-employed (they need to check self-employed box on the form and submit)

-Spouse is employed – if the spouse is employed and they include the cost of coverage under their employment and do not elect that coverage a rate form is no longer required by the group.

400

252

252-Charge(s) denied. Inpatient benefit maximum has been met. Refer to Schedule of Benefits in your Benefit Booklet.

400

CVS/Caremark number 

800-552-8159

400

MMNAE

Major Medical Non-accident Emergencies

400

Shingles Vaccine

Routine Care > Immunization > review the HCR vaccine list linked in this tab

500

is there a penalty for no prior auth?

Failure to obtain precertification will result in no coverage for All Related Charges (includes all ancillary services).

500

what do we need if we see code 546

Only for use when medical records are needed for retro authorization.

500

HealthSCOPE Electronic Payor ID:

40026

500

IC_VMX_MMMCH

I = Individual

C = Calendar Year

VMX = Visit Maximum

MMMCH = Major Medical Mental and Chemical Dependency

500

Wrong Surgeries

Covered/ Excluded Services

M
e
n
u