Groups
For this group we only create HIB, IP cases
Golden Rule
This tab should never be used for PA Requirements if found on the PNL
PNL Edits Tab
True or False:
X11453 has limited SNF Benefits
TRUE
This service setting should be used for all surgeries taking place in a hospital or ambulatory service center
OUTPATIENT FACILITY
This is the TAT for cases
15 Calendar days
For this plan, we should always select the group number with the "78...."
Surest
OrthoNet acceleration process via email applies to groups that use this PNL
Commercial PNL
X05727 group number belongs to this plan
NTCA
All future inpatient procedure should include this
CPT CODE
The general GAP note template is found on this tab of the Note Note Template Job Aid
QUICK NOTES TAB
This group's name that starts with a "U" is one we no longer manage.
USHealth
True or False: For qualified retro BH cases under the GEHA Traditional PNL, we should transfer and not provide a fax # for clinicals.
FALSE
78800247 belongs to this active Group number
X12942 - Assured Plans - City of Moore
To bypass the 'hard stop' in ICUE, you should select this option for your [Source] on the Initiate HSC Screen
OTHER
Claim remark code "AS" means it'll pay at this rate
Pays claim as INN rate
This group uses its own job aid for reference after the code is found on the PNL
HCA
On this PNL, you can determine which codes require activation
Surest
GEHA Aetna X13019 transitioned to this group number for 2024
X09471
TRUE or FALSE: Acceleration requests for ORTHONET should be updated on Tab8. Assignments & Alerts tab
FALSE
We should refer to this SOP for guidance on what information needs to be verified to start a case or release information
HIPAA Job Aid
The ID Numbers for this group will have a "R" in them
Railroad plan - X11121
(Found on IQR)
On this PNL, you can determine which specific plan has no OON Benefits and which has no SNF Benefit
GEHA Elevate (Elevate/Elevate Plus)
This Group # has a prefix of 440
X14198 - Jasper Holdings
Claim Remark Codes can be found on this tab
5. Decisions Tab
This should be used when asking a question in the leadership chat
Help Template