Failure To Pay
Member statements are sent by this date
What is by the 10th of each month
Template for COB should be noted here in NoteCube
What is A/P
Check here prior creating an OD
What is CCMS
Doc ID for Illinois Networks
What is RES21814
Pulmonary Function Testing falls under this Benefit Class
What is Outpatient Services
Direct number for IQOR
What is 1-866-897-4904
Used to identify other insurance coverage available to medicare bedeficiaries and determine which insurance carrier is primary whn a benecificary is covered by more than one insruance plan
What is Coordination of Benefits (COB)
Cigna-HealthSpring files a customer's request in a call tracker and routes it to the appropriate Precertification department.
What is Internal OD
All Networks within Texas use evicore except these networks
What is Renaissance Physician Organization(RPO) and El Paso Integral Care (EPIC)
This can take up to 14 calendar days to resolve
What is standard Authorization
Member is disenrolled from this due to not making payments
What is Optional Supplemental
Members will recieve this when CMS communicates that member has additional coverage
What is COB Notification Letter
Submit when a member feels that they are entitled to a specialist(ie: i need to see a cardiologist)and the dr is not willing to submit
What is Orginazation Determination
This is the only region that does NOT use evicore for radiology Utilzation Management within the whole region.
What is Kansas
This is the only network name within the Florida Region starting with the letter "S"
What is Sacred Heart POD
Members will receive this (TOTAL) amount of notices once the fail to pay process has completed.
What is 4 notices
A member is 65 or older or entitled based on disability and has retirement insurance only. Who pays first?
What is Cigna-HealthSpring /Medicare pays primary
This type of OD Cigna-HealthSpring warm transfers the customer to the delegate who handles their specific request.
What is External OD
Name of the network with the Arkansas Region
What is Health Spring of TN- Memphis
Member is looking for a new primary within Jones, MS 73049. She needs to have a location that is accessible by wheelchair, she doesnt feel comfortable with a male dr, and needs to be accepting new patients. whats the dr's name whos specialty is internal medicine.
What is Grettel Rosali Rodriguez Garcia
Mailing address for payments in Alabama
Cigna Health Spring
P.o. Box 742642
Atlanta, GA 30374-2642
A member is 65 or older,and is covered by a Group Health Plan (GHP) through current employer Walmart. Who pays first
What is The Group Health Plan (GHP) pays primary
Orginazation Determination can be submitted by (Need full list of who can)
What is customer, or an individual who represents the customer who is appointed or authorized to act on their behalf (such as a relative, friend, advocate, attorney, or any physician). These include callers who do and do not have Power of Attorney (POA) documented in QNXT.What is customer,
Member calls in and needs to see if a Prior authorization is needed. Her husband is leaving the hospital after a nights stay and she was advised that he will need to have a home health nurse. Will she need a prior authorization. She lives in Texas.
What is yes
3 types of prior authorization forms
What are Provider Prior Auth Generic Form, Provider Prior Auth Durable Medical Equipment Form, and Provider Prior AuthHome Health Form