Unlisted CPT codes
"Not otherwise specified" code
What is an unlisted code?
Viewing detailed information about the health plan, subscriber information, and mismatches
What is the response history?
A formal request for a patient to receive care or services from another healthcare provider
What is a referral?
Approval from an insurance company that says a specific healthcare service to be covered and paid for
What is an authorization?
Document utilized to provide explanation of what is being performed
What is a letter of medical necessity?
Column on the right hand side of Epic
Verification Checklist
Referral is not required due to contract with BCH and health plan
What is PPOC?
Document why a patient is receiving care, support billing and insurance claim, track public health data and outcomes.
What is diagnosis code?
CPT Code for PAO Hip Procedure
What is 27299?
Insurance typically for individuals 65+, however individuals can be eligible based on disability and/or end stage renal disease.
What is Medicare?
Require referrals for all Plans under this payer
What is ALL Fallon Health Plans?
For extra points per health plan, can you name the Fallon health plans?
Berkshire Fallon Health Collaborative, Fallon 365 Care, Fallon Reliant Medical
Current Procedure Terminology
What is the acronym for CPT?
CPT code Facility and Anesthesia codes for Dental procedures
What are 41899 & 00170?
Government Health insurance program that provides low-cost or free health coverage to people with limited income and resources
What is Medicaid?
Where referrals are documented
What is the referral # space in the auth/cert?
Pre-determined text utilized in the communications section for ease of use and understanding
What is a smart-text?
CPT code for Larynx Procedure
What is 31599?
Type of health insurance plan that covers only specific services or provides capped benefits, rather than full, comprehensive medical coverage
Plan is required to have an active PCP referral on file before submitting authorization
What is an HMO plan
Standardized Medical Code used to describe services, test, and procedures being performed.
What are CPT codes?