KMS Topics
Caller: "My dermatologist is in Portland and I want to know if he is in-network, his name is..."
What system would we use to verify if doctor is Par?
Under which topic will you find the scenario for Orthotics?
Bonus: For all plans besides Standard plans, what is the dollar amount limit for Orthotics
What is Durable Medical Equipment
Bonus: $200
Caller: "I want to know if my acupuncturist who is in Portland is in-network. His name is...."
What system would you use to verify if provider is par
Caller: "I want the pin so I can use this Providence E-Card app"
What program to you use to find the Pin?
Caller: "I need a DME provider and I am in Eastern Oregon"
Where would you find DME provider that services Eastern Oregon?
Caller: "Can you tell me if CPT code 85324 requires a PA?"
What Program would you use to verify this information?
Caller: "I need help finding a counselor"
What system would you use to find member a counselor?
Caller: "I have a letter stating my Prior Authorization was partially denied. What was denied?" What program would you use to get more information on partially denied PA?
What system would you use for more information on a partially denied PA?
We paid too much on a claim and the Provider needs to send money back; under which topic will we find the PO box for the provider
Bonus: What is the Po box #?
Refund and Recovery
Bonus: PO Box 6456
Caller: "I am in New York and need help finding a DME provider"
What directory would you use?