Reimbursement Policy
What is the number of minutes that equals 1 unit of anesthesia?
15 minutes
The system that houses all claims for Oscar?
Cortex
In-network providers will always have one of these.
Contract
What is the most common pricing methodology for provider claims?
CMS
Which type of Cotiviti denial is always escalate to Cotiviti for review?
CV
Nurse practitioner is this type of provider per the reimbursement policy?
Mid Level
What is the name of the system where all provider contracts are stored?
Faxblast
Documents in Faxblast such as Settlements, NDA's and Joinders will never include this?
Fee Schedule
What does an escalator do to pricing?
Increases it
How can you view the NDC number in Cortex?
Actions, View/Edit raw claim
E&M codes billed with REV 510-519 on a UB04 claim are not reimbursable. What type of facility does this apply to?
Hospital Based Clinics
What is the name of the system where member profiles can be reviewed?
Rosco
What is the name of the page in the contract that shows the contracted rate?
Compensation
What are the 2 most common pricing methodologies for Inpatient claims?
DRG and IPPS
What kind of reduction is applied to radiology services billed on a UB04 claim?
TC override/TC modifier reduction
What does the modifier 26 represent when billed with a cpt code on the claim?
Professional Component
What is the name of the tool where we can check eligibility?
Elbow
What type of document in Faxblast, might include an updated fee schedule?
Amendment
What is the pricing methodology where Oscar pays a set amount for each patient that is attributed to that provider?
Capitation
In order to price an unlisted procedure code, the processor must first obtain this type of code from PI?
Comparable
What type of anesthesia provider must bill with modifier QX
CRNA
What is the name of the tool where all of the pricing dashboards are located?
Looker
What type of facility would a contract that as UCC in the name have rates for?
Urgent Care Center
What type of pricing method states that if the billed charges for a specific REV code exceeds the threshold, Oscar will pay a percentage of charges for the amount over the threshold?
Second Dollar
What is the name of the reduction taken when a provider submits a bill for an E&M code and a surgical code on the same date of service with a 25 modifier?
Global Reduction