Pumpkin Pie
POS 81 is for this location.
What is a lab?
Whether or not a PA is required for 95869.
What is no? However this is not a guarantee of payment, and all services are subject to medical necessity, eligibility at the time of service, and cannot be cosmetic, experimental or investigational and are subject to plan exclusions.
The age a member needs to be in order for no PA to be required for a Zoster/Shingles vaccination.
What is 50?
How an in-network provider in Oregon would update their remit address with PHP.
What is contact their PR rep?
The three ways a member can submit an appeal or grievance, and the specific information of where to send it.
What are:
1. Mail: P.O BOX 4158, Portland, OR 97208-4327
2. Fax: (503)574-8757 or (800)396-4778
3. Email: phpappealsandgrievances@providence.org
Danielle from Dr. Laurel Westly's office/TIN 930798039 (Tualatin location) is calling to find out where to mail a claim for MBR ID 100523075-00.
Where is PO Box 3125 Portland, OR 97208?
The dollar limit that CSR's are able to make POS exceptions for. (And where this information is housed in KMS)
What is $500 and the Customer Service topic?
What UCR is based off of.
What is the average rate of reimbursement for a given service in a given area.
BONUS Bragging Points: Can we know what the UCR will be prior to receiving a claim?
The reason why CL 183515756900 denied.
What is not a covered benefit?
BONUS Bragging Points: Whose responsibility does it fall to?
Whether or not a PA is required for 42226.
What is yes?
Whether or not a nerve conductive study requires a PA or not.
What is no PA required?
***QD***
Whether we paid for CL 173473003500 by check of EFT, if/when the check or EFT was cashed/deposited, and whether it was bulk or a single check.
What is paper check? When is 01/18/18? What is single check?
The number of levels a Fully Large member has for an appeal.
What is 3?
BONUS Bragging Points: How many levels does an individual member have?
Using MBR ID 100550534-01, tell me what the member's primary MBR ID # is. (Dual member)
What is 100792905-00?
The location code (POS) that an immediate care bills for services.
What is POS 11?
BONUS Bragging Points: What benefit(s) do we quote to the member?
The place where we can refer members who have additional questions regarding PMG doctors, classes offered at Providence facilities such as birthing classes, etc. (Portland-metro area only)
What is the Providence Resource Line?
Tiffany from Dr. Seth Stankus' office/TIN 911939739 (J Street location) is calling to find out where to send their claim for MBR ID 100522976-00. They want to send it electronically.
What is submit to FCHN Payer ID: 91131
The CPT code approved on PA/Ref # P259601 for MBR ID 100834638-00.
What is CPT code 19318?
The network used for a rural area within Oregon, such as Roseburg, where the EPO network is not available.
What is the PPONOEPO network?
The two days of the week that checks are cut for the commercial line of business.
What are Tuesdays and Fridays?
The date span listed for MBR ID 113016995-00 and Reference # 190021373.
What is 01/01/19 - 12/31/19?
True or false: An individual choice member can be seen by a specialist in Arizona and utilize the First Health network to receive in-network benefits.
What is false? No in-network benefits outside the state of Oregon, besides UC/ER.
The number of office visits allowed and if any have been used for MBR ID 113236853-00 and Dr. Jeani Buhl.
What is 6 allowed and 1 paid?
Whether or not PHP accepts retro prior authorization requests.
What is no?
The name of the primary insurance listed on file for MBR ID 100118445-01.
What is United Healthcare?