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Health Plan
SYSTEMS
Ambetter Vendors
Miscellanous
Ambetter Claims and Guidelines
100
**************DAILY DOUBLE**************** For the following Health Plans have the same timely filing guidelines.
What is MHS-IN, Buckeye-OH, Sunshine-FL, Peachstate-GA Home State-MO, Magnolia-MS & Celticare-MA.
100
You will always use this system during the authentication process.
What is CRM?
100
*************Daily Double**************** This vendor handles our DME, Home Health & Home Infusion Services.
What is Univita?
100
****************Daily Double****************** Member HIPPA verification requires that you verify ____ pieces of indentifying information.?
What is three (3) type of verification?
100
For Ambetter lab claims what piece of information must be on the claim?
What is the ClIA number?
200
This Health Plan has 180 days from the DOS for First Time (Initial) Claims within its plan.
What is Ambetter Coordinated Care?
200
What system do you use check a providers Hat Code?
What is Portico?
200
*************** Daily Double ********************* Dental Services are covered through this vendor(s) for Centene Corp.
What is Dentaquest or Dental Health and Wellness
200
CeltiCare Health is the branding for which Ambetter Health Plan.
What is Massachusetts?
200
This claim form is used for Hospital, Facility and Nursing Home billing.
What is a UB04 or CMS 1450.
300
This is the address used for what type of claims Ambetter (Health Plan Name) PO Box 5000 Farmington, MO 63640
What is Disputed Claims?
300
We use this system to check if a provider is listed as a Non Par provider.
What is Portico?
300
Most Ambetter Health Plans use this vendor for there vision care.
What is OptiCare?
300
Managed Health Services is the branding for which Ambetter Health Plan?
What is Indiana
300
A HCFA is what type of claim form.
What is a CMS 1500 form.
400
*********DAILY DOUBLE************ For all Ambetter Health Plans, providers may submit claims via:
What is the Secure Web Portal on Ambetter Website What is EDI What is Paper
400
All claims are processed and filtered into this system(s).
What is Amysis and CRM?
400
Our Prior Authorizations go through this vendor for most of our Health Plans
What is US Scripts?
400
***************Daily Double********************* How many pieces of HIPPA information is needed to authenticate a provider and what are they?
What is Two Tax ID and NPI Facility/Provider Name & NPI Facility/Provider Name & Tax ID
400
The Taxonomy code must be on the claim for Ambetter providers; which field is this located on the CMS 1500 and UB04?
What is box 24J of the CMS 1500 (above NPI) What is box 81C of the UB04
500
This is the address used for what type of claims Ambetter (Health Plan Name) PO Box 5010 Farmington, MO 63640-5010.
What is an initial (first time) claim What is a resubmitted claim What is a corrected claim What is a reconsideration claim
500
You can view all paper claims and remittance advises through this system.
What is the Emdeon?
500
This vendor handles our radiology provider's needs?
What is High Tech Imaging?
500
What form is used to update the provider's demographics, legal name or address.
What is a W-9
500
True or False All member updates to their Ambetter health plan is handled through the Health Insurance Market Place.
TRUE 1-800-318-2596