Benefits & Eligibility
how many frequency per day value for cpt code 22220
Maximum Frequency per Day Value Indicator =1
is authorization required for code 11644
POS : Office
no auth required
Prior Authorization IS required for Outpatient Hospital setting Only
what is taking money back from a Provider and not repaying it.
recoupment/recovery
what tool do we use to check if referral is required ?
Referral requirement tool
OON
Out of network
M ember : 125566890 / Harpreet Singh
Is there an active plan for DOS 05/17/2022
no , Not Eligible
Is authorization required For CPT 99205, office visit is for evaluation for a transplant,
Yes authorization is required , Refer to optum
kind of denial where the provider/facility has submitted multiple claims for services rendered on the same date(s).
Duplicate Claims
tool that we use to check for other department contact number
PSA REdirect tool
BH
Behavioral Health
to which address can Pv send the medical record
Optum :
attention medical Records
P.O Box 105067
Atlanta GA 30348
What are the two states that can request authorization over the phone
Texas and Arizona
What do we call when providers need to correct errors on previously submitted claims
Corrected Claims
This is where the provider can check the status of the claim , benefits and eligibility as well as authorization requirement
UHC provider Portal
FLN
The film locator number
what is the CSP Network prefix for
Colorado Monument Health One
EXGO
what is evicore's phone number
Phone: 1-866-889-8054
What is a complete listing of fees used by Medicare/Medicaid to pay doctors or other providers/suppliers
fee schedule
A tool that serves as our guide when we are creating authorization
Authorization entry Grid
ICES
Ingenix Claims Edit System
What is Mississippi corrected claim timely filing
12 months from remittance date
for authorization A197961746
what is the start date and end date /what is the procedure code and DX
what is the status of the authorization
status : covered/ approved
DX : N85.02
cpt : 58571
Service Start Date:05-22-2023
Service End Date:08-20-2023
what is the status of claim # 22F077023000
details of the claim /explain the denial if there is any.
memebr ID : 122444385
Disallow Expl Desc - No. 1 - This service is included in the payment/allowance for another service
Per CCI edits, Proc G0444 bundles to HxProc 99213 of Claim ID- Ext/Int Line ID 22E557045700 -1/13.
Where can a provider and advocate check for reimbursementy policy
UHC portal
PDAT
Provider Data Aggregation Tool.