QicLink
I am the program you use to find the number of visits that have been accumulated.
HCQ
1S
This is a non covered service under your plan
Two places in the Customer Service module where the pre cert vendor can be found
Summary of Benefits and Insurance card
When I am required an examiner will fax a form to the provider of service to initiate me.
MNR (medical necessity review)
What is the Medicaid timely filing deadline?
36 months/3 years
I am the program you use to check if a pull code has been used.
CM
28
Deny for Coordination of Benefits
When a vision claim is received by email or mail we go here to obtain a DCN # and create/hand stage a new claim
Image only claims
I am the Director of Operations at Auxiant
Angie Cooling
What two remark codes must be used when coordinating with Medicaid?
MA / 36
You can type "dup" here, or "refund request" while processing in CEA or CA. I can be seen in HI. I am called the C______ H______
Claims Header
29
Deny for accident details
This is where to check if an assistant surgeon is allowed
Trilogy Handbook
This is the law that was passed in 2010 that mandated 100% coverage for in network preventative care
ACA or PPACA or Obamacare
What do the letters in the PEARH(S) rule stand for.
Pathology, Emergency, Anesthesiology, Radiology, Hospitalist
Hill
1T
Non Covered diagnosis under plan
I am the vendor some members HAVE to go through for spine and joint procedures.
Edison
This maternity rule timeframe allows for what length of stay following delivery?
48/96 rule
In HI, in order to see remark code descriptions you use which key?
%
2T
Benefits have been coordinated with Medicare
You can find employee lives, where ID cards are sent and other group information here
Transmittal
Name one of the two pre cert Vendors we have to warm transfer to.
Cigna or AIMM
MLR stands for _____
Medicare Like Rates