Auth or Yes
MnR SPECIFICS
Guess What
SOPs
Benefit
100

How many procedure codes are allowed in each case?

14 codes

100


What does the acronym SNP mean?


 Special Needs Plan

100

We don't provide Benefit information for delegated plans?


False

100

What is the title of the job aid for delegated plans for Intake?


Plans Not Handles by M&R Intake

100

What is the payer ID to submit claims for WellMed?


WELM2

200


What is a written order from the member’s primary care provider for the member to see a specialist or get certain health care services?

 Referral

200

In order to take advantage of Medicare, a person must be a U.S Citizen aged 65 or older, Citizen under the age of 65 can also use Medicare if they have a qualified disability. 


True

200

For delegated plans specifically to WellMed , UHC only handled eligibility and benefit. Prior Authorization requirements should be handled by the delegated department.

True

200

What is the title of the Intake Job Aid for Accelerating a case?

Case Review Acceleration

200

How long is the benefit period when the member hasn’t been IP at any hospital or Skilled Nursing Facility?

60 calendar days

300

How many days is retro referral allowed?


5 calendar days from the Date of Service

300

What part of Medicare combines the Part A and Part B options and optionally provides Part D drug coverage, as well. This is also known as “Medicare Advantage” because, in most cases, it is a lower cost alternative to Original Medicare?

. Medicare Part C

300


What tool should be used in checking if a certain procedure code was already billed in the past?

CPA

300

What Intake Job aid title will you check if provider is asking for an observation authorization?

Observation Stay Notifications FAQ

300


What is the Knowledge Library indicator for services that falls under OP - major diagnostic?

Lab, X-ray, and Major Diagnostics- CT, PET, MRI

400

How many days do a retro-authorization for IP cases?

  93 calendar days from the discharge date

400

What do you call a code that starts with a letter, followed by two digits, then a decimal which also helps identify why the patient went to the doctor?

ICD

400

We automatically transfer the provider if the call is for dental benefit

False

400

What Intake Job aid title will you check if you need to manually route a case?

Intake of Medicare and Retirement ICUE/HSR Work Queues

400


What is the limited service code used in CPA, in checking the accumulation for routine vision exam ?

 41

500

 What should be the correct network steerage if the member is aware that the provider is OON?

  Patient Electing to use OON Provider

500

 What is the amount that the member pay for health care services before the health insurance begins to pay?

 Deductible

500

LIS Copay Field in Spire with zero indicator means, we follow the Low Income Subsidy Index?

False

500

What Intake Job aid title will you check if you will create a case with missing information?

Request with Missing Information

500

What is the first dollar payment that applies to the allowed amount before the rest of the benefit is calculated?

. Copay

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