Benefits
Does cataract surgery fall under vision insurance or medical insurance?
Medical
Where do you route claims for an adjustment aka "second look"
DRW – Dollar Review Box UNET
If a diabetes diagnosis code is present in any position on a claim for a diabetes screening, would the preventive benefit still apply?
No
Where you can find the balance bill process?
Claims Advocacy
This is the northern MN way of saying I love you. When someone is leaving you advise them to watch for
Deer
If a diabetes diagnosis code is present in any position on a claim for a diabetes screening (ex 82947), what benefit would the test fall under?
Diagnostic lab
In order to send a balance bill, the provider must be what?
OON
What type of breast pump is standardly covered in conjunction with childbirth?
Double Electric (aka Dual Electric)
Contains the RMO fax numbers
Building Trust Through Advocacy
Can lift 20 times its own body weight
Ant
This benefit typically requires a PA over $1,000
DME
What are the two remark codes that may be present on a claim denied for commercial COB?
SF and 7Y
What is the age requirement for a cervical cancer screening (pap test) to be considered preventive?
21-65 ends on 66th birthday
This discusses the Women’s Health and Cancer Rights Act of 1998
Benefits and Coverage Advocacy
Hold each other’s paws so that they do not drift apart while sleeping
Otters
What is the standard distance for a network GAP exception?
30 miles
What is the critical situation in which we can fax EOBs? (hint: there are 2 requirements)
The member has a court date within 3 - 5 days AND Five or less EOBs need to be faxed.
What shingles vaccine is preventive for age 50 years and up?
Shingrix
How to handle Receiving a call from someone you know
HIPAA Advocacy
Can taste with its feet
Butterfly
On plans without therapy limits, after how many visits will manual claim review (MCR) be required?
30
Effective January 1, 2018, there is a maximum frequency of BLANK# dates of service for presumptive drug testing and BLANK# dates of service for definitive drug testing per member per calendar year.
18,18
What is the required diagnosis code for all lactation counseling cpt codes with the exception of S9443?
Z39.1
This animal breathes through their butts
Turtles