Can you hear me now?
Do we use submitted procedure codes for hearing aids?
What is....no! We will default to V5298 or V5274.
What diagnosis code gets enter in the first ICDA Code field for routine eyewear?
What is...H52.7.
What is the ORS box we route to for DMR Hospital claims?
What is...430 DET HMR.
What procedure code do we use for a custom oral appliance?
What is...E0486
If we have two members on one UFE, when do we need to get them split?
What is...when they are not spouses.
What denial code do we use for V5299?
What is...1165/7003.
What reason code do we use for payable post cataract eyewear lines (frames, lenses, uv, ect)?
What is...1361/7040. These are priced per a fee max.
If our DOS occurs after the received date, what do we do with the claim?
What is...route to 401 RES MBR. We cannot enter claims with future DOS.
Do wigs get processed through the DME section of the 382?
What is...no! The 382 directs us to use the All Other Reimbursement section.
If your division is not known, what screen do you start your member search in?
What is...the GI703.
Are OTC Hearing Aids covered in 2023?
If any upgrades or coatings are submitted and bundled with post cataract lenses, what two upgrades do we need to DE in addition to the lenses?
What is...UV V2755 and Prism V2718.
If you receive an ORS with additional information for a claim in development by another processor, what do you do with the ORS?
What is...route the ORS to the processor who put the claim into development.
When a code shows up as rental only (RR) on the DME POS SP, are you required to submit to the SME SP?
What is...No, you will use the CL520 to determine if the DME Fee Field is populated.
If we cannot find an effective timeline for our member, what do we do with our claim?
What is...route it to 401 RES MBR.
RANDOM QUESTION! How many minutes are in one week?
What is...10,080 minutes.
If you have routine and post cataract eyewear with the same DOS, what pair should be entered as post cataract?
What is...the pair with the highest claimed amount.
What ORS box do we route CarePlus claims to if needed?
What is...we don't! We use an email template.
If a DME item is supplied directly by a physician, do we need to check if the provider is Medicare certified?
What is...No, the PI will direct us to pay the claim.
If the month and date of the member's date of birth are transposed, is that an allowable discrepancy to make a match? 05/06/1950 vs 06/05/1950
What is...yes! 05/06/1950 vs 06/05/1950 is an allowable discrepancy when searching for our member.
If the system does not auto deny the claim, what reason code do we use if a member's ibaag states the member must use UnitedHealthcare Hearing?
What is...1153/7065
RANDOM QUESTION! What are the five Great Lakes?
What is...Erie, Huron, Ontario, Superior & Michigan.
DAILY DOUBLE: If you need to route your ORS to another department but the ORS is created under the incorrect member number, what do you need to do before routing the ORS?
What is...create a new ORS under the correct timeline/division to route and close your current ORS.
What modifier do we put in the Mod1 field for shoe inserts with a diabetic ICDA code code?
What is...KX
DAILY DOUBLE: When searching for a member, if you're trying to make an address match and nothing matches in the EP400 what is the secondary screen we can use?
What is...the EP402.