High Dollar Reviews
Amount that COB claim have to go thru the Front-End High Dollar Review Process
What is $15?
Claim Payment Amount exceeds maximum allowed
What is Edit 135?
An international agency sponsored by the UN; addresses serious health concerns around the world
Who is the World Health Organization (WHO)?
Unique add to QNXT for TX MP Errors
What is Root Cause Attribute Error?
State that Tom Martin live in
Where is Florida?
Requirement for every High Dollar claim
What is a MEMO (Documenting the Process)
No Active Provider Contract
What is Edit 101?
Agency that regulates food and drug products in the US
Who is the FDA? (Food and Drug Administration)
The custom Inpatient Payer ID for most providers with Medicare prime contract for Marketplace LOB
What is 09MP?
The new pricing tool that has replaced Webstrat in some states
What is NetworkX?
$ Amount that requires a Health Plan Approval
What is claims paying over $99,999?
PCP is solely responsible for service
What is Edit 153?
Agency concerned with the cause, spread and control of diseases in the US
Who is the CDC? (Center for Disease Control and Prevention)
the TIN# and Hospital Facility/provider name that has teaching Hospitals with IME Payment
What is 741152597 & Memorial Herman Facilities?
The person Frank Condo reports to
Who is Jim Woys?
HD Turnaround Time
What is two working days?
UM has no available units.
What is Edit 611?
Agency that oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces.
Who is CMS?
the Payer ID specific for Memorial Herman Facilities for TX MP
What is MPOIME?
PEND Code that must be used when the auditor PENDs a claim as result of an audit error found in QNXT
What are Market Place claims?
What is HD reviewed based on Eligible amount?
No Enrollment Exists for Claim Start Date
What is Edit 201?
Agency that establishes and enforces standards that protect workers from injury and illness
Who is OSHA (Occupational Safety and Health Administration)?
New Rules for Marketplace All States for Non-PAR providers related to ER admit when PA is not on file
% of your retirement contributions that Molina match up to every pay period
What is 4%?