Credentialing
Pend Codes
Contracts
Abbreviations
Everything Else
100
This database is used to research a provider's credentialing history
What is Mercury
100
You resolve this pend code by assigning a contract to the Vendor ID
What is QC1000 - Multiple Payment Contracts Found -OR- QC 1001 - No Payment Contract Found
100
This is the appropriate point-of-contact for contract related questions
What is PNM
100
DOS
What is Date of Service
100
This series of practice office suffixes is used when the provider is a facility
What is _5000
200
This credentialing event requires the PSV tab be reviewed.
What is CAQH
200
This pend code is added by PDM to indicate PDM updates are complete.
What is HNPDMCOMP
200
This abbreviation is added to the end of Acute Care Hospital payment contracts
What is FAC
200
PDM
What is Provider Data Management
200
This is the amount of time Health Net has to complete a claim before the claim is considered aged
What is thirty days
300
This amount of time reflects how long a provider's approved credentialing event lasts before expiring
What is three years
300
This pend code can be resolved by linking a practice office ID to a provider file
What is QC1018 - Practice Office Not Effective
300
These three professional provider specialties require a specialty payment contract
What are Audiologists, Acupuncturists, and Ophthalmologist
300
PC3
What is Patient Centered Community Care
300
This date reflects the PC3 program start date
What is 1/6/2014
400
This network will be assigned to a provider working under a PC3 contracted TIN who has NOT been credentialed
What is HNNNCP
400
This action is taken to clear PDM pend codes after PDM has resolved the issue(s) causing the pend(s)
What is clear adjudication
400
These three states require a carrier number be assigned in the payment contract
What is New York, Missouri, and Kansas
400
NPI
What is National Provider Identifier
400
This box on the claim form should be used to select the appropriate practice office NPI for a claim entry in QC
What is box 33
500
This type of provider may be assigned the PC3HN network, but may not have a credentialing record in Mercury
What is MHN (Behavioral/Mental Health)
500
This pend code occurs when a provider's NPI in the provider file was assigned to be effective after a claim's date of service
What is QC1019 - Provider ID not effective
500
This is the default rate assigned to IND Multiplan providers when no fee schedule is listed in the Multiplan extract
What is 85M85V60B
500
VA
What is Veterans Affairs
500
This feature is used to determine the appropriate CMS identifier for a practice office record
What is Locality Look-Up
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