SHP Programs
This insurance is designated for children whose families earn too much money to qualify for Medicaid, but cannot afford to purchase private insurance.
What is CHIP?
The definition of procedure code 97022.
What is APPLIC MODAL 1/> AREAS; WHIRLPOOL
IQ0200
Provider Search
What does PSQ stand for?
Pay Service Qualifier
This team is responsible for pended inventory, adjustment requests, correspondence, appeals, and projects.
Claims Shop
This program is a fully integrated Managed Care model for individuals who are enrolled in Medicare and Medicaid.
What is MMP?
The definition of Modified T5
RIGHT FOOT, GREAT TOE
PR0300
Provider Affiliation
What field is considered a mini payclass and also contains configured PSQs that Amisys recognizes first
Except Fee
This team is Responsible for processing Macro/BOT requests that are submitted and are processed according to instructions provided.
Automation Team
Which Medicaid program services low-income families, but could have a copay?
What is CHIP?
The definition of procedure code 33362
REPLACE AORTIC VALVE OPEN
Claims by Member
Is a corrected claim considered an appeal or a reconsideration?
Reconsideration
This team is Responsible for generating and sending recovery notification letters to providers when a claim recovery is needed.
Recovery Team
This ACA Health Insurance Marketplace is a cost sharing plan offered by Centene.
What is Ambetter by Superior HealthPlan?
Definition of Modifier 50
BILATERAL PROCEDURE
IQ3400
Fee Schedule
If a provider submits a written request for reconsideration or to appeal a decision, what two things must be included with the request?
Reconsideration or Appeal form and all applicable documentation/medical records
This team is Responsible for building and implementing the behavioral health business rules so that BH claims auto-adjudicate correctly.
Configuration Team
This program is a Medicaid Managed Care program for acute and long-term services and support, for children and young adults aged 20 and younger.
What is Star Kids?
Definition of Modifier TC
Technical Component
RM0100
Remarks
If you receive an inquiry questioning an auth related denial for LTSS services, and you are able to find an auth in TruCare Cloud, however, the auth did not cross over into Amisys. Which department should you work with to have the auth crossed into Amisys.
CAT Team
This team is Primarily responsible for provider education, issue resolution, provider satisfaction, and regional network awareness.
Account Management