Claims
How many number of ways can providers submit claims?
what is 3
How many levels of appeals are there?
what is two
What is the Annual Enrollment Effective Date?
What is Effective January 1st of the following year
The amount the member has paid out of pocket
What is troop
Used to locate membership information, eligibility claim history, authorizations, and call notes.
What is member tab
What are the ways providers can submit claims?
what is
Provider Portal
Electronicially through Clearing house /EDI
Paper Copy
What is a Provider appeal?
what is An appeal is anytime a provider disagrees with a decision we made about coverage.
When is the Annual Enrollment period
What is Between October 15 and December 7
The catastrophic Stage
What is stage 4
Used for researching and analyzing out-of-state claims.
What is ITS
How many digits does a claim number have?
what is 12
Who handles level 1 provider appeals?
what is the appeals department
When individuals first become eligible for Medicare, they can...
What is join during a 7-month period that begins 3 months before the month they turn 65, including the month they turn 65
The prescription number assigned by the pharmacy for the dispensed drug.
What is Rx Number
Used for enrollment, letters, applications, initial contract set up, and member record changes.
What is IKA Gateway?
What Edit verifies the member is active/effective on the date of service?
what is eligibility edit
How are level 2 appeals received?
what is Always received by mail/fax.
The only way a Tribe member can apply with Premera
NCPDP number of the pharmacy that submitted the claim.
What is Pharmacy ID
Contains the member current and past plans.
What is eligibility?
What box number does Professional Provider fill out when correcting a claim on for CMS-1500?
what is 22 (Resubmission Code.)
What are the 5 types of provider appeals?
what is Timely Filing, Pre-Service Review, Claim Denials
Payment Disputes, Medical Necessity
In order to be eligible for enrollment in a Medicare advantage plan (4 answers)
What is
Tier that includes generic dugs at the lowest cost.
What is Tier 2
Contains ID Card requests, call center inquiries, uploaded documents, etc.
What is other info?