Benefits Lookup - SC
For 3HZN42735710, what is his deductible for INN and OON services?
500/750
What is the INN deductible for NJ Direct 15 (Local Education) per the NAEGS?
NONE
For 3HZN42735710, what is the status of the claim ending in 9202 with a DOS of 3/4/20
Rejected
What country code would be used for someone traveling to Switzerland for an International Travel Letter?
CHE
What is the phone number for eviCore?
866-221-8787
For 3HZN42735710, how much has he paid toward his OOPM for the year 2020?
Per 2025 NJ Direct 2035 (SHBP), what is the out of network OOPM?
$6,500
For 3HZN42735710, what are the procedure codes for the claim ending in 2100 with a DOS of 3/4/20?
99204, 45378, 31535
For 3HZN69469620, what is the status of the authorization dated for 1/2/2020?
Pended
Name a Contiguous County
Add a Task > Benefits and Costs > Benefits and Cost > Resources > State of NJ Contiguous Counties
For 3HZN70994020, what is his co-insurance for a dermatologist visit?
20%
For 2025 CWA Unity Direct 2019 (Local Gov), how many nutritional counseling visits are allowed per period?
3
What would denial reason code M759 signify?
CANNOT PAY FOR THIS SERVICE AS IT HAD NOT BEEN RENDERED BY THE PCP
For 3HZN69469620, who is this member's assigned case manager?
CM - HOR - Merck Nurse Team
What vendor would I send someone to if they had a question regarding a medication they were prescribed?
OptumRX
For 3HZN70994020, look at an emergency room visit. What is the co-pay, co-insurance and deductible for this service? (hint! could be more than one section to quote!)
Institutional: $500 deductible applies, 20% co-insurance, $0 copayment
Professional: $500 deductible applies, 20% co-insurance, no co-payment
What are hot tubs classified as under 2025 NJ Direct 1525 (SEHBP)?
Exclusions
How many times has a claim ending in 3408 been adjusted?
4
For 3HZN43796620, what is the Confidential Communication password on file for Eli?
Praveen
What address would I advise a member to send medical appeals to?
Horizon BCBSNJ
NJ DIRECT/HMO or OMNIA appeals
PO Box 420
Mail Station PP 12 E
Newark, NJ 07101-0420
For 3HZN62736460, how much is the member given toward wigs if deemed medically necessary?
$500 every 24 months
How many egg retrievals are allotted under 2025 SHBP SEHBP - HMO 10?
4
Where is the place of service for Member ID 3HZN42735710, Claim ending in 7400, DOS 3/4/20?
2 - Hospital Outpatient
For 3HZN69469620, what user ID documented a phone call on 6/12/20?
wawid514
What is the service center number for a member who is traveling internationally?
Globalcore - 1-800-810-2583 or collect at 1-804-673-1177