CLAIMS
FACETS
PROGRAMS/APPLICATIONS
DENTAL
RANDOM
100
POS / 11
What is the facility code for Office?
100
Type Description : 32
What is the HCP code for primary care physician?
100
PTRACK
Where do you look up Third Party Administrator information?
100
Prophylaxes
What is the medical terminology for a cleaning?
100
Hematologist
What is a physician specializes in diseases of blood?
200
Form HCFA 1500, Box 13
What is the assignment of benefits?
200
BSBS (Family Planning)
Where do you locate benefits and coverage for infertility, family planning,and elective abortions?
200
I PROVIDER
Where do you find Dental fee schedules?
200
Emalgam
What do we always downgrade to for fillings on posterior teeth?
200
DAW (Dispense as Written)
What is the abbreviation used by Doctors on a prescription advising the pharmacist to not convert to a generic or other equivalent drug?
300
Agreement ID
What is the fee schedule.
300
Member Authorization
Where do you locate privacy authorizations? (Transfer/MemberAuth)
300
Fast Cert Table
Where do you locate if a CPT code needs precert or not?
300
Network Set
What do you do to confirm if a Dentist is INN or OON?
300
IOP
What is the acronym for Intensive Outpatient?
400
Media Viewer
How do you locate and view members EOB?
400
COB --> Update --> Carrier ID: Search
How do you update the coordination of benefits?
400
Encoder Pro
Where to breakdown modifiers and codes for billing?
400
Applicant Type: Not Assigned
Where do you locate that the member is an initial employee?
400
48 / 96 Rule
What is the allowed time for delivery and c section, before pre certification would be required?
500
62308
What is Cignas payor ID number?
500
CDHP (Consumer Driven Health Plans)
Where do you transfer to provide FSA/HRA/HSA amounts and get more detailed information?
500
File Net
Where do you locate images or correspondence from customers and/or providers?
500
Status 18 (On a Dental Claim)
What shows that a claim is on file but not truly a claim it is more of an estimate?
500
MRC2
What is the fee schedule called if its over the 100th percentile?
M
e
n
u