PCP Changes
This is the role you will route to for PCP Changes
What is: R036- MA Medicaid Specialist
True or False: If COB is involved, Medicaid always pays first
What is False?
What is True
When you are filing a grievance for a member, this is the subject and category you should use
What is: Grievance/Appeals, Grievance/Appeals
There are _ pairs of suite tickets to see Forrest Frank on 04/29
8
How many days do members need to select a PCP?
What is 30 Days
What section in Facets will you look for more detailed information for COB?
What is Related Notes / Subscriber Notes?
Who sent the payment out when the Dispersement Method says External Check Payment?
What is Zelis
Please pull up Claims Inquiry-WEB and input
243413620600 - The billed amount and date of service for this claim is
DOS: 12/02/2024, billed $266.00
____ to a Person and _____ to a Reason
Pend & Route
These are 4 things needed in your task note when you route a PCP change off
What are:
Please pull up Claims Inquiry-WEB and look up Claim #
243454663100. The allowed amount from EOCCO is
What is
$108.17
MED2710 - Researching Payments and Recoveries
Please pull up Claims Inquiry-WEB and input
243582923500
The Clinical Edit denial for this is
u49 - Age Conflicts with Diagnosis
Pull up the Focus Chart and look up CPT 40819; This is the Guideline Note that goes over Frenotomy for tongue tie in newborns
Guideline Note 139
This P&P goes over how to select PCP
What is: MCD8?
Please pull up Claims Inquiry-WEB and look up Claim #
243524954000. The amount paid from the Primary Insurer is
What is
$127.17
In the Payment Application within the Accounting Application - pull up Payment Reference ID:
2021123110500489. How many claims are involved a recoup/recovery?
2
Please pull up Sub ID YC800M0J in Benefit Tracker - No Prior Authorization is required for all combined therapy visits until the ___ visit?
What is the 61st
Please pull up the Practitioner search in Facets and search - P00000768662. What is the Provider Group that this Practitioner is a part of?
University Professional Services
Pull up Sub ID:
YM701F3W - This person is listed as their current PCP
What is Yakima Valley Farm Workers Clinic Hermiston?
Please pull up Claims Inquiry-WEB and look up Claim #
243113822100 - What is the name of the member's primary insurer?
Medicare
Search the Payment Application for Check #1301343. What is amount of this check that was paid out?
What is $297.60
What are:
Please pull up the Practitioner search in Facets and search - P00001418767
The EIN/Tax ID listed for this provider
What is: 930425580