FAM vol II
What information can be found in Exhibit 9?
Valid Plan codes for Claims Processing
FEP Blue Focus option, CT scan, in the office
Yes, auth required
What does FCR stand for?
First Call Resolution
PPO Anesthesia services are covered at 100%, member pays nothing
Basic
What chapter can information on Claims Processing and claims coding guidelines for compound drugs?
Chapter 9 - Special Coding Situations
Daily Double!!!
Standard, MDCR PRIMARY, Residential Treatment IP admission
Yes, auth required
What is the fax # for the UM dept?
602-864-4274
Specialist office visit copay of $35.00
Standard
Benefits are not provided to Preferred and Member facilities for the treatment of Hospital Acquired Conditions (HAC) or Preventable Medical Error (PME) when a claim is submitted with an _______ Diagnosis Code, which is related to medical care.
E-Diagnosis Code
Basic, Outpatient ABA Therapy
Yes, auth is required
Daily Double!!
There is a 60 second dead air time maximum when you are on a call
False!!
30 second ‘dead-air’ maximum
Self Only - $6,000 Preferred, $8,000 Non-preferred out of pocket maximum
Self Plus One or Self and Family - $12,000 Preferred, $16,000 Non-Preferred out of pocket maximum
Standard option
In order for nutritional counseling to be covered as preventive, it must be billed with what diagnosis code?
Preventive care benefits are provided for individual and group nutritional counseling regardless of the diagnosis code
Standard option, Observation via ER admit
No auth is required unless IP admission.
Would a newborn be eligible for benefits for a circumcision if father is currently enrolled under group FEP105?
Yes, since member is already enrolled in a self plus family
Daily Double!!
PPO: Patient is responsible for 30% of the Plan allowance, after deductible.
What is the deductible?
FEP Blue Focus, $500 indvl/$1000 family
True or false
Under Standard Option, Basic Option and FEP Blue Focus, FEPExpress provides benefits for After-hours Care when the services are rendered in a Physician's office setting (POS 11) and one of the Procedure Codes below:
99053 and 99050
False, 99050 and 99051
cpt 77301 icd-10 C131
No, auth not required
What additional information goes in the "Contact Info" field when creating a contact?
Callers name and callback number
What is the standard option copay for an office visit when a member has Medicare part A only as primary?
PPO: Patient is responsible for $25 copay to a primary care provider or $35 copay to a specialist, (no deductible).