PEBB
The dollar limit for orthotics for a PEBB Choice member.
What is $200 per calendar year?
The types of providers that can deliver babies.
What are: Family practice (vaginal only), OBGYN (vaginal/cesarean), CNM (vaginal only), high risk (vaginal/cesarean), any class of licensed health care practitioner acting within the scope of their state licenses, licensed midwife (vaginal only) and licensed direct midwife (vaginal only).
What are: Cholesterol screening (one per calendar year), diabetes screening (one per calendar year), Hep C Virus screening for adults both between 1945-1965 (one screening), HIV screening/counseling and syphilis screening?
Whether or not hearing aid batteries are covered.
What is no? (Not a covered service)
KMS stands for this.
What is Knowledge Management System?
The visit limit for nutritional counseling done in-network for 2018.
What is no limit?
The exclusion listed under home birth.
What is: Home water births are not covered?
The two facilities known to have a 3D mammogram machine.
What are Providence Milwaukie and Legacy Good Samaritan?
PHP contracts with pharmacies for the flu shot only during flu season. Flu season occurs during this timeframe...
When is 09/01-04/30?
The reason why CS heavily utilizes KMS.
What is it includes information about benefits such as coverage criteria and exclusions and also has claim processing information?
Whether or not a PA is required for a sleep study done in the member's home.
What is no?
The amount of time a member can get a breast pump prior to delivery if obtaining through Providence Home Services.
What is 60 days prior to delivery?
These groups are religiously exempt from covering contraceptive services.
Who are: Franciscan Montessori Earth School, Mt Angel Abbey, Oregon Catholic Press, Archdiocese of Portland and LaSalle Catholic Preparatory?
The diagnosis that must be billed for a Nexplanon to be covered-in-full.
What is contraceptive?
The part of KMS that contains coverage information and exclusions pertaining to a particular service.
What is the Benefits section?
The exclusion called out for pool therapy.
What is "Pool therapy in a class setting is not a covered benefit"?
The current HCPCS code for Skyla IUD is this.
What is J7307?
The name of a specific imaging center who is non-participating with Providence for diagnostic imaging.
Who is EPIC Imaging?
The network that applies for a SAIF member for vasectomy's.
What is "Any Willing Provider"?
The part of KMS that contains information that is regularly asked/checked on.
What is the FAQ section?
These are the HCPC codes that are covered for compression stockings for a PEBB SW member.
What are A6530 - A6545 and A6549?
*Bonus bragging points: Is there a limit on how many the member can obtain?
The PA requirements around a CPAP machine.
What is "effective 09/01/16 CPAP requires a PA for both the rental and convert-to-purchase"?
Whether or not a tens unit, CPT E0720, would pay or deny with a diagnosis of a migraine headache or not.
What is deny?
*Bonus bragging points: Does it deny to member or provider?
The massage therapy limit for SAIF members.
What is $1500 per calendar year; combined with chiropractic manipulation, acupuncture and massage therapy?
The part of KMS that has documents utilized relating to that specific topic page.
What is the References section?