CORRESPONDENCE
What is the EOB route for?
To explain benefits of a claim
are EHBs mandate to be covered through the Affordable care Act?
yes
If a member has already met the deductible, does that guarantee the next covered service will have no member cost?
No, coinsurance or copays may still apply
How often is fluoride varnish application recommended for all infants and children starting at age of primary tooth eruption through 5 years of age?
Every 3 months for all infants and children starting at age of primary tooth eruption through 5 years of age.
Are members able to use fax or email as a delivery method?
No
According to the "Procedure" note, which two systems set up Essential Health Benefits (EHBs) differently than how they previously appeared in Engen systems?
HRP and FOS
What should you verify before explaining a specific benefit to a member?
The member’s plan.
What are the three main types of services included in preventive care?
checkups, cancer and other health screenings, and immunizations
What information should we add on the accumulations letter route? AT LEAST THREE xD kim did this
how many plans must include the EHB?
Small group (2-50)
What is the fixed amount a member may have to pay when receiving a covered service?
Copay
How many doses of the Hepatitis B vaccine are covered as preventive care for children from birth through 30 months of age?
Dose 3
What is the route that we need to send if a member wants to check a medical service coverage?
Confirmation of coverage
Where we can check the individual benefits, cost-sharing and coverage?
FOS
If a service is covered, does that always mean the member pays nothing?
Using Member ID 6006379200 (child 03), how often is alcohol and drug use/misuse screening and behavioral counseling intervention covered under the preventive care guidelines?
Once a year for ages 11+.
What sub-area is needed on the route to obtain the Tax Year End Statements?
1099
What does the NEB stand for ?
Non - essential health benefits
According to the “ Laboratory Services rules, what action must a provider take if they cannot perform a specific test that a patient requires?
Provider must contact IBX for preapproval or a referral.
Using Member ID 6006379200 (Child 03), is the Dengue vaccine covered as a preventive immunization?
The Dengue vaccine is covered for ages 9 to 16 years in endemic areas only.