Verifying Medical Benefits
How many steps are there to verify medical benefits?
7
What would you convert 1 year into if the dosing was 1 injection once every 4 weeks?
Weeks
This stands for Current Procedural Terminology. They are used to bill Cigna for the administration of medications and are typically 5 digits.
CPT
What medical system are most member located in?
TruCare
2.2
These are the requested Start and End date of the authorization. These dates will not exceed 1 year.
Dates of Service
What field is used to enter the member ID in ICMS?
AMI
What is the calculation for Units Per Dose?
Full/Request Strength x Billable HCPC / Vial size
This stands for Healthcare Common Procedure Coding System. This is the code that is assigned to a medication for billing purposes. They are 5 digits and some can be alphanumeric or all numeric.
HCPC
What do you do if the member is not found in TruCare but has a migration date in ICMS?
Add in TruCare
What is the formula for finding Total HCPC Units?
This is the exact amount of medication that the provider wants to give. This means there will not be any "per" given.
Full Strength
What Line of business does not have a department for us to contact in regards to benefits so we treat this as being unable to locate the customer?
IFP Account
What two pieces of information do you need in order to calculate BSA (Body Surface Area)
Height (feet and inches) and Weight
What 3 words can mean the prescribing physician?
Requesting, Referring, Prescriber