MSAG
Where can providers find a copy of the MSAG?
Carelon BH Website > Provider > Forms and Guides > Guides
What is the INN rate for 90837 performed by a Psychologist?
$115.12
Someone calls in to ask about an outpatient therapy benefit, which you provide. What codes do you use?
BEN012 Action Code
BEN511 Reason Code
What state do we manage Medicaid for?
Maryland
The number of pieces of information needed to verify HIPAA
3
90849
What is it?
Covered under SUNI?
Auth?
Multiple Family Group
Yes covered under SUNI
Yes requires an Auth
Member ID: MD000015132
NPI: 1790013902
How much does this provider get paid for CPT 96130 (as of 7/1/25)
$179.37
A provider calls in to verify member eligibility dates. What codes?
Reason: ELI122
Resolution: ELI501/ELI502/ELI512
What is the maximum hold time?
2 Minutes
What 3 pieces of info do we use to HIPAA verify participants?
First and Last Name
Date of Birth
Participant ID
W5050
What is it?
Covered under FDUA?
Auth?
Horticultural Therapy Individual - certified
Yes Covered
Yes Auth
How much can a Nurse Practitioner bill for CPT 90791
$168.02
A provider calls in with questions about an authorization details
Reason: AUT0103
Resolution: AUT543
Send me the names of 3 Specialty Programs
Varies
What 3 pieces of information do I need to HIPAA verify providers?
Full Name of Provider or Facility
NPI/TAX ID
Full Service Address (or billing/pay)
For CPT Code 99202, what do the add on codes mean?
They add 30, 45 or 60 minutes
Participant: MD000015132
Provider NPI: 1881804128
CPT: 90791 with add on 90834
$235.66 + $141.31 = idk math it's Friday
A member says they have spoken to the state regarding updating their COB but it is not reflected in our system. What codes?
Reason: CLM037
Action: COB002
What are our business hours?
8-6 EST M-F
Name 3 situations where we would need to verify/reverify HIPAA?
1. Beginning of the call
2. When a new person joins the call
3. When the call drops and we make an outbound call to the person we were speaking with
What category does W7350 cover? What does this mean?
SUD, participant must have primary SUD diagnosis
How much does the provider make:
Member ID: MD000015180
NPI: 1477068187
CPT: 99204
Provider is not licensed appropriately to bill for this service
A member has a question about receiving/scheduling ABA services
Reason Code: ABA001
Action Reason Code: REF014
What is our program's toll free number?
800-888-1965
How would this address need to be said in order for it to count as valid HIPAA verification?
154 Apple Hill Drive
Suite 234
Chicago, IL 60613-2543
154 Apple Hill Drive
Suite 234
Chicago, IL 60613