Claims
This is the number of calendar days that a participating provider has to submit for a claim Reconsiderations or Claim Dispute.
What is 90 days?
Documentation for this should be completed with in 5 business days.
What is an interaction?
This recognition program was development to identify medial practices that have invested in a model of care that puts patients at the forefront.
What is Patient-Centered Medical Home (PCMH)?
This line of business will have 'MP' in the plan indicator position of a claim. Which is the fifth and sixth digits of a claim.
What is Ambetter/Marketplace claims?
Example: Y024MPE77388
This is the only line of business that can be submitted in P360 to request for configuration updates.
What is Medicaid? (Sunshine)
This Request Type is for when the provider states they never received a payment and ask for an offset.
What is Void and Reissue Check?
This system allow PE to submit Claims MPIP provider concerns to be reviewed by an analyst.
What is P360?
This screen in Amisys allow the user to locate any Project numbers (PROJ-#) associated with the claim.
What is Remarks Inquiry? or
What is Screen RM0100?
Leaving this field to the defaulted 'NO' option when creating an issue ticket in P360 indicates that the ticket should be shared with external contacts through an automated email.
What is Internal Ticket?
This request to assist with recuperation provider concerns was thought to go through P360 but in March 2025 Provider Operations Dept confirmed that those request would stay in Service Now.
What is Negative Balance/Recoupment/Recovery Issues.
This fee schedule is used to base MPIP rates off.
What is Medicare Fee Schedule.
This provider type will always show a blank attribute field in Portico.
What is Group Practices provider types?
Double Jeopardy: For 800
This formula is used to calculate the MPIP Rate.
What is Medicare rate - 2% sequestration = MPIP rate.
Provider pricing/payclass must be less than 167% of Medicaid fee schedule. Anything higher will not see the increase for MPIP.
This system allows PE to submit for MPIP loading issues for when practitioner is not loaded with PCMH status and needing a data maintenance request.
What is CenProv for MPIP Loading issues?
Double Jeopardy: For 1000
These 4 directory resources are impacted when the provider is showing Excluded from Directory in Portico.
What is Ambetter Guide, Printed Directory, Find-a-provider tool, and OMNI?