This is the trigger number for an authorization edit for an in plan provider.
What is trigger 6?
100
These are the two other terms that may be used when referring to an out-of-plan provider.
What is non-par and out-of-network?
100
This is the UMC you would use to deny a service for no sterilization consent form on file.
What is EXCR?
100
This is the UMC you would use to deny a claim for invalid or inappropriate modifier billed with procedure code?
What is UMC EX0P?
200
This is the trigger number for an MOU.
What is trigger 37?
200
This is the system code to use when denying a claim for no authorization on file.
What is code 160?
200
This is the name of the department where we send issues for review of iCES edits.
What is MRC?
200
This is the tab under the member's profile where you would check to see if HR has been updated with acknowledgment of receipt of a valid sterilization consent form.
What is the UDT tab?
200
TOB stands for this.
What is type of bill?
300
This is what you would do if the MOU on file is not relevant to the claim.
What is waiving the MOU trigger and paying the claim?
300
This is the DX code range for mental health claims.
What is 290-319?
300
This is the long name for NDC.
What is Nation Drug Code?
300
A sterilization consent form must be signed a minimum of this many days before the procedure.
What is 30 days?
300
This is the type of claim form used by hospitals to bill for services.
What is a UB-04?
400
This is the tab within the member's profile where MOUs are found.
What is the attachments tab?
400
This is the UMC to use to deny a claim with a matching auth that has no units left to use.
What is EX39?
400
These are the long names for PT, OT, and ST services.
What are Physical Therapy, Occupational Therapy, and Speech Therapy?
400
This type of annual visit must be billed with modifier FP.
What is a family planning service?
400
This is the trigger that hits on a claim with an OON provider needing an auth.
What is X4?
500
This is the other type of review, besides MOU, that trigger 37 can also refer to.
What is a transplant case?
500
This is one service rendered by an out-of-network provider that does not require any type of authorization.
What is an Emergency Room service?
500
This is name of the department that reviews 413 triggers.
What is the pricing department?
500
This is the minimum age to consent to a tubal ligation with Medicaid.
What is 21?
500
This is the EX code to add to a COB claim when the service is either THSteps, SB 58, or Family Planning and no EOB is attached so FC pays as primary.