Authorizations
Where is the first place we should look to see if authorization is required?
The Focus Chart
What does claim status "02" mean?
Accepted; Batch Completed
That is was submitted electronically
Claim # 24299B1000154241
Was this payment made via EFT or paper check?
EFT
What is the subject/category for a call where we helped find an INN provider for a member.
Provider
Search: is provider in network / Search: other
Does CPT 0692T require PA?
Yes
What does claim status "11" mean?
Pended; Awaiting Batch
How many claims images are there for Member ID HT201N2B
24
Claim # 242554109300
What was the allowed amount and paid amount for this claim?
$113.58 Allowed
$102.22 Paid
Under which category would you find "Sleep Study"
Diagnostic & Imaging Services (Lab & X-ray)
Who reviews PAs for CPT 72191?
Evicore
If a claim denies with a Clinical Edit denial, can we send it back for adjustment?
No
What is the maximum amount of results Content Manager will show at one time?
250
Claim # 243205667100
Who is the provider for this claim and what is their specialty?
Chelsie Hutson
Licensed Mental Health Counselor
A provider is calling, where do you document their NPI or Tax ID?
Under SSN/ID
What is the expedited turnaround time for an authorization?
72 Hours
If an INN claim processed OON, can we send the claim back for adjustment?
Yes
What three things can we use to search for a claim image in Content Manager?
Claim ID
Document Reference Number
Subscriber ID
Claim # 251142952700
Why was no payment issued for this claim?
Capitation Applied
What is the subject/category for a call inquiring about coverage for a vision exam.
Vision Benefits
Exam
Is this a funded pairing?
CPT 40650 / DX K14.0
No
What should you do if you see the denial:
84M - DMAP Registration Required for Payment
Obtain the NPIs that were included on the claim and verify them in MMIS.
What can we use to search for claims received on or around a specific date?
Advanced Search
Claim # 242990002500
What was the total bulk amount this payment was for and what was the EFT number?
$116,119.49
24299B1000154241
What should you do when a caller provides their SSN?
Mask the call