Claims
Using Claim 51678305/01 What was the Payment on it?
What is Full PT Responsibility $665 DED
Using Group Cammebys Management Plan CB Quote Chiropractic Benefits.
What is INN 90% After a $40 Co-Pay. Calendar Year Maximum 25 visits. ; Chiropractic Services: OV, manipulations and X-rays are covered under 1 copay per visit and the co-insurance. or OON 60% Deductible Applies. Calendar Year Maximum 25 visits.
What does the Benefit Suffix P mean?
PPO Network
For Zoeller Group Plan A3 who is the Utilization Review
American Health Holdings
What Page would you use to find a Suffix for Accumulations?
Benefit Suffix
Using Claim 48944463/03 what was the Patient Responsibility?
$0 per QL
$298928.44 per EOB as Inelligbile becomes Patient Responsibility
Using Group Cammebys Management Quote Infertility Services
Diagnostic Testing 90%. Lifetime Maximum $5,000. ; Artificial Insemination is not covered.
Treatment 60% Deductible Applies. Lifetime Maximum $5,000. ; Artificial Insemination is not covered.
What is the Code you would use to search Physical Therapy Accumulations?
PT
For Zoeller Group Plan A3 is PreCert required for Outpatient Surgical Procedures?
What is Yes per Benefit Pointe
What page would you use to help Member with their ID Cards?
What is ID Cards
Using Claim 52109374/01 What is the Status of this claim?
Line 1 denied as Duplicate Charge
Line 2 with the rest denied as +q DIAGNOSIS DOES NOT WARRANT PROCEDURE.
Line 3 Denied as Duplicate Charge
Lines 4,5,6 were $0 on Submitted Charges
Using Zufall Health Center Plan C8 Quote Bariatric Surgery
What is unable to quote Plan Exclusion
What is POS 11?
Physicians Office Visit
For Cammebys Management Group Plan CB would PreCert be required for E0640?
What is Yes E0640 is DME and found on both BP & Cigna PreCert List
What page can help you determine what a CPT, HCPCS, DX code may fall under?
Codes - CPT, HCPCS, ID-10 (DX)
Using Claim 52109374/01 What would the Claim Submitter need to do to get this claim reprocessed?
Claim submitter may submit a Corrected claim.
Using Zufall Health Center Plan C5 Quote ABA Therapy
$30 copay/100%; Limited to 30 visits per Cal Yr.
What code would you use to search Durable Medical Equipment Accums?
DME
Using Davidson Oil Company Group Plan A1 would 70555 require PreCert
Yes per BP & HC PreCert List
What Page would you use to help Quote Benefits
Benefit Quote
Using Claim 53213807/02 what is the General Claim Status?
REC 12/4/24
Proc 12/10/24
Finalized 12/11/24
TC $225
Allowed Amount $225
Amount Paid to PV $157.50
PT Responsibility $67.50 Coinsurance
Using Zoeller Company Plan A4 Quote Bariatric Surgery
Covered for the treatment of morbid obesity after meeting the following criteria shown in Plan Doc Pgs 51-52
For Dental Fluoride what code would you search in Accums?
What is DPRF
For Cammebys Management Group Plan CB would PreCert be required for 0586T?
What is Yes found on both BP & Cigna PreCert list as Transplant
Using Provider Relations W9 page, What can PV relations do?
Provider Relations will update the TIN or Address
They will email you with an update that the TIN or Address has been updated
You will then be able to proceed accordingly:
Route your call to the processor to request the overpayment from the incorrect address and reprocess it to the correct address
If necessary, send a Check Tracer request (if the criteria is met)