Claims
member id 60038306 // search 8/6/2026 total charge $966 // what is the provider and member responsibility?
Advocare Delgiorno Peds and adult medicine
$5.13
UMI 6013830400 Emergency services
deductible $500 // coinsurance 20% after deductible // OOP max $2500
6013830400 what is the remaining OOP max // policy holder
$2488.46 of $2500
what plan apply for away from home ??
HMO / POS
HMO need referral for Physical therapy and whit location they need to used ??
yes and capitation site
member id 6006095800 // claim 20260213528429 //
what is the status for line 1 and 2 ??
Approved 1
Denial 2
UMI 6006095800 what is the benefit for Durable medical equipment ?
deductible $0
coinsurances $30
OOP $4500
precertification need it
umi 6006095800 policy holder whit member is more closed to meet the OOP max ??
spouse
for global core what is the number for calling out site of usa area ??
011-804-673-1177
what is need for urgent care out of the 5 county's are for HMO plan ??
UMI 6003064304 claim 20260714525853 whit line have a cost share apply and what is the member responsibility ?
line 39 copay $100
UMI 6003064300 what is the benefit for 71045 ?
deductible $0
copay $40
OOP max $4500
Referral need it // capitation for radiology need to be used
umi 6003064302 spouse // the member already used the serv Prev_Exams_A and P set 2 lim ??
used 1 remaining 0
check if this npi 1639259583 is able as pcp for adult ? if the answer is yes proc the pcp id and capitation site
NO ,it is pediatric location
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community radiology of hup
labcorp of america
Novacare
PCP id 4000155158
PPO plan need authorization for cpt 72148 and 71550 ??
yes for the 2 cpt codes
claim 2026141057548 // what is the total charge , allowed amount , member responsibility , which type of cost share was apply and when the claim was process ?
Total $228
allowed amount $64.34
member Responsibility $64.34 deductible
Process day 5/30/2026
umi 2515395400
Group 3004808
benefit plan id 29079
what is the preventive schedule ??
IBC standard preventive
Benefit limitation can be extended whit precertification or referrals ??
what is the job aid name and id for Jefferson call ?
Highly sensitive and confidential - Jefferson health system JHS negotiations doc id 3375
check claim 20251211537156 why is denial ? check whit claim is the correct one
duplicated claim
correct claim 20251031528283
what are the benefit for diagnosis and initial testing // Gift
group 3165843
plan id 47435
deductible $1500
coinsurances 90% after deductible
OOP max $9200
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Gift non eligible
umi 6007696700 child // member already used serv preventive_vision_screening_acuity ?? if yes when ??
yes /DOS 7/29/2026 20260806526150
what are the question that we need to completed before give the id over the phone ??
second verification
what is the time frame for back day a referral and precertification
referral 30-90 days // precertification 24-48 hours //
after day of serv