Miscellaneous
What is an ARL?
Authorized Recipient List
If a vasectomy office benefit says "paid same as comparable services" what benefits do you quote?
Office visit with specialist, office surgery, Office Services & Supplies Surgical
Is court ordered diversion an exclusion in Oregon for substance use disorders?
No
In provider network which department does not have a an extension?
Provider Contracting
If a member has downloaded the Weight Watchers app and has started the program. How much will they be eligible for reimbursement?
$40 per CY
If a member is going to an eye practitioner for glaucoma, what benefits would we quote?
Office visit w/ specialists
How many levels of appeals does a member on an ASO group get?
As many as their contract states
What department sends out medical service questionnaires?
TPL (third party liability)
What form does a provider use when trying to get authorization for partial hospitalization for mental health?
Behavioral Health: Preauthorization Request Form
Who does Pacific Community College pay their premiums to?
PacificSource directly
What benefits would you quote for knee surgery?
Outpatient Hospital or ASC, Surgeon, Anesthesia
What is the TOS code for drug testing?
8350
If an individual direct member wants to check on the status of their application, what extension would we call to inquire about the status?
2585 Individual Services
If a member on an individual Montana plan lives in a rural area and the closest in network provider is 1 hour away, can they request an NNA (Network Not Available) so they can see the local doctor at in network rates?
No, Individual plans are not eligible for NNA's
What type of provider is Norco?
DME provider
Can a member get physical therapy via telehealth?
At this time yes
In Montana, how would you search for a Board Certified Behavioral Analyst for a member needing applied behavioral health?
Specialty category: All other facilities
Specialty: Autism Clinic
What would you do f an agent calls stating they think they are not being compensated correctly?
Transfer them to an agent coordinator at ext 5489
Where would you see a medication authorization?
CT Viewer
Where would you find the group reps name for a Group policy?
In Related Entities
What benefit would you quote for CPT 96570
Office services/supplies non-surgical
In the resource page, where would you find information about Osteopathic Manipulations?
Chiropractic Services
If someone in Woodburn calls in asking what types of plans we offer, where would we direct this caller?
To the exchange or to the other carriers in their county
If a medication is not found on a drug formulary, what does a member or provider have to do?
Send a preauthorization medication exception request form