PPI
Protected personal information about services, supplies, and drugs related to STDs, HIV, chemical dependency, reproductive health, gender dysphoria, gender affirming care, domestic violence, behavioral health and _______ _______ is considered sensitive.
What is genetic information?
A restriction on the amount of time a provider or member has to submit a claim is called a ______ ______ _____.
What is timely filing limit?
These benefits are considered essential care and, so long as they're billed in a way that indicates there wasn't an existing problem, will not apply to cost shares.
What are preventive benefits?
Need to contact another BCBS or a provider's office, but you've either made multiple attempts already or are quoted a wait time of more than five minutes when you try? Send this request to the Project Team.
What is a callout request?
We can only escalate a prior authorization request that is less than 15 days old when it's been submitted as one of these kinds of requests.
What is an urgent request?
Parents calling about their children almost never need an authorization to speak to us about things other than sensitive claims, and this is true whether they're on the plan or not. One notable exception is when the child is the _______.
What is subscriber?
If you see one of these in BlueSquared when researching a SCCF, there is a host/par plan situation that the processing site needs to consider in the adjudication of the claim.
What is an SF code?
The difference between this kind of imaging and basic imaging is that the many imaging techniques used allow physicians to visualize organs, tissues, bones, and blood vessels in a way imaging services like x-rays and ultrasounds can't.
What is advanced imaging?
Paul Aranoia would like his entire accumulation history for the last year because the amounts he's being billed by some of his providers "just aren't making sense." He knows they're out to get him! Better send one of these!
What is a spreadsheet request?
Magnus Mann wants to speak to a supervisor right away! Unfortunately, it's been over ten minutes since you sent out a request for one and none are available. What can you send for this member?
What is a supervisor callback form?
Oh, no! The Authorizations extensions in Facets isn't working. Not to worry, because we can also check for authorizations in this tool.
What is the Disclosure Tracking Tool?
Claims for care that a person received last year that are submitted this year will process to ____ year's benefits.
What is last?
What many expectant mothers don't realize is that this benefit only applies to their own care, not baby's, leading many on the Health Connect Plan to believe that the cost of their newborn's hospital stay would be included in their own $500 bundle.
What is Maternity Care?
Got a member traveling to another country on Microsoft's behalf? They may ask you to have one of these sent to them.
What is an IPOC?
J. Jonah Jameson called to see why we haven't approved the knee injection request his provider sent two hours ago. He's scheduled for tomorrow afternoon and wants it approved now! Unfortunately for him, scheduling issues are not a matter of ___ ___ ____.
What is life and limb?
This is the only part of a member's email address that we can disclose.
What is the domain name?
Claims that don't have a payment issued for them will still sometimes have remittance information such as a check number, transaction ID, etc. because the payment was issued for the _____ rather than the claim itself.
What is batch?
Don't already own one of these devices? In that case, you'll need to rent one first - we don't permit purchase of these in lieu of rental for sleep disorder patients.
What is a CPAP device?
Paul Aranoia is back, and he's asking that we do one of these to make sure all of his cost shares were applied correctly. He noticed his deductible amounts on the portal were showing $2,500 satisfied, but his deductible is only $1,500.
What is an accumulator review?
What is MsftAmznCorpClEsc@PREMERA.com?
When someone has asked us to prohibit the disclosure of PPI to a specific person who normally has access to this information, we call that a ___ ________ _______.
What is a non disclosure request?
Claims that have these applied to them have billing errors such as improper code combinations that the billing party needs to fix before we can process the service to a member's benefits.
What are clinical edits?
Need an endoscopy done? Be prepared, because despite the camera taking pictures of what's inside your upper GI tract, this service will actually apply to the member's outpatient facility and outpatient professional benefits, because rather than an imaging service, this is considered one of these instead.
What is a surgery?
Seymour Specialists has had eight claims in process for two months, and is adamant that we get them processed pronto since he's expecting at least $5,000 back from us. What should we send to the Project Team?
What is a bulk claim adjustment request?
Vanessa Marianna has reason to fear for her wellbeing if her ex-husband, Wilson Fisk, obtains any of her personal information. She needs an NDR for herself and an OBRA NDR for their son, Richard, as soon as possible. Who might be able to escalate this request?
Who is the Appeals Department?