Eligibility and Benifits
What is the Maximum Frequency per Day Value Indicator for hcpc A4557
Maximum Frequency per Day Value Indicator =2
is authorization required for cpt code 15734 with DX F64.9
Yes, authorization is required
what is the status of the claim #22E517146000 for member id : 122270839/ AMANDA M SAALFRANK
Processed to co pay
allowed amount : 4.35
copay : 4:35
In CCI Editing Policy, Professional and Facility reimbursement policy, will UnitedHealthcare Individual Exchange allow both codes of a CCI edit to be reimbursed?
Which policy Nummber ?
Yes
Policy Number 2023R0105B
tool where we check if codes are valid and billable
KL
what is the eligibility and Type of plan for
Member ID : 124253179
member name : Anneliese Gieringer
effective date : 01/01/2023
RMHP Colorado Doctors Plan Silver-C $75
Exchange Silver
Is authorization required for cpt code 0362T (BEHAVIOR ID SUPPORT ASSMT EA 15 MIN TECH TIME)
Yes, authorization is required
What is R33 Denial ?
The requested records were not received or were not received timely.
diagnosis code B94.0 in a claim is being denied for Inappropriate diagnosis code
to which reimbursemnet policy would you refer them ?
Policy Number 2023R0122C
Inappropriate Primary Diagnosis Codes Policy
A tool where we check the status of an appeal
ATS
Product ID : B0IL0001 / Group Id : ILONEX
what is the benefit for cpt code 45378 with diagnosis code z00.01
Preventive Care Services
$0.00 Copay, 0% Coinsurance, Deductible does not apply
Is authorization required for 90839 (Psychotherapy for crisis; first 60 minutes )
No authorization required
Provide Information on 411 alert for IFP with ID # 15521 and date : 11/08/2023
the fax number (888-404-0940) listed for IFP Provider Standard Appeal request in the Provider resource tool and the 2023 Provider Administrative Guide is incorrect.
The correct fax number is 888-404-0949.
This has been corrected within the Provider Resource Tool and will be updated in the 2024 Provider Administrative Guide.
In which reimbursement policy can we check if For cpt code 76802 is reimbursible
Policy number : 2023R0064B
Obstetrical Ultrasound Policy,
Tool that we use to send EOB via FAX
Right FAX
What is the CSP NetworkPrefix/Pre product code for Colorado Valley Health
EXGV
Pv wanted to send clinical for authorization with cpt code 25442 . to which fax number they need to send it
Please fax clinical to:
· OrthoNet Fax # 844-881-8934
what is the status of the case ID # AT-3790076-W and what is the reason for that decision
Mem ID: 122498073
Member name: BUREN L FURR
claim # 22P863202502 / Dos : 12/07/2022
Case ID: AT-3790076-W Case Status: Closed Case Outcome: Uphold Latest Outcome:Uphold
OUTCOME:
Uphold - no referral on file
The provider is asking What is The primary code needed if the add on code is 0054T , what will be your best response?
A. Provide the appropriate Primary code
B. provide the reimbursement policy asked and them to check with their biller or coder
B. provide the reimbursement policy asked and them to check with their biller or coder
Tool that we use to send the claim back for manual reprocess
MACESS
In Global maternity benefit , Delivery is quoted in which benefit
Inpatient Benefit
Gap requests are evaluated base on what ?
GAP requests are evaluated based on whether there is no other INN specialist that can service the patient and based on a geographical need and medical necessity.
What is the difference between service is not covered under members current benefit plan and member not eligible for benefit Denial ?
service is not covered under member current benefit plan ---OON provider
member not eligible for benefit -- No active policy during the DOS
The claim is denied for gobal days for cpt code 11462
the provider is disputing and saying that this is a treatment for postoperative complication
To which Reimbursement policy would you refer them
Policy Number 2023R0005C
Global Days Policy
Tool that we use to check a claim that is not on file yet
Echo