Eligibility
What are the 3 mandatory questions that need to be asked to complete VOI?
What is members' ID number, full name and date of birth?
What category would you use for an office visit related to a mental Health diagnosis.
what is MIDA office service
What category would I look at to see if there are special benefits for a chiropractor?
What is category - Therapy > sub category - chiropractic
What does ACA stand for?
What is Affordable Care Act?
What category would I look at to find the benefits for an outpatient facility charges for an knee surgery?
What is outpatient facility?
What are the 4 types of coverage BCBS offers?
What is Single, Single Plus dependent, 2-Party and Family?
Preauthorization requirement that I must give all callers for MIDA.
Preauthorization is needed for any outpatient visits over 90 per calendar year of more than 4 hours of psych testing per c/y
True or False all policies have a 60 visit maximum for physical therapy?
what is False
What is the frequency limit for a colonoscopy?
What is one every 5 years for members age 50 and older?
Where would I advise a Nebraska provider to look to verify if preauthorization is needed?
I would direct them to Navinet so they can submit the preauth electronically
If a group is ASO what does that mean?
Group is considered self-funded. ASO stands for Administrative services only
What does MIDA stand for?
What is Mental Illness, Drug and Alcohol
What is a physical therapy evaluation and will it count towards my session limit.
The physical therapist will perform a detailed examination to evaluate the patient condition and take measurements of the impairment to help establish a treatment plan. This will not count towards the therapy maximum.
True of False, All plans must follow ACA guidelines and cover preventive care at 100%
What is False?
For ID 100056844, how would a surgery to remove a wart in the In-network Dr office be covered?
Per the special group handout for City of Fremont, plan will pay 100% up to a maximum of $300.00 per visit. Once the maximum is met will be deductible/coinsurance
What date would I use from the CAT eligibility tab if the Provider is asking for the effective date?
What is Continuous Date- this is the effective date with no gap in coverage?
What one mental health provider is not covered by any of out policies?
What is a Licensed marriage and family therapist
What would be the most common exclusions you see?
What do I need to know about the shingles vaccine?
The vaccine is considered a routine immunization for members over the age of 50. Anyone under that age will need to have a preauthorization.
How will the physician be covered if they are Out of network but the facility I go to is in network?
Per the benefit predictor aid all professional charges at an in-network facility will be processed as in network and the member will be liable for their in network cost shares and anything over the allowed amount.
What size groups are not required to offer COBRA?
What are Small groups with less than 20 employees.
Name 2 exclusions that see under the MIDA exclusions?
What are Recreational therapy, biofeedback for substance abuse, sexual dysfunction therapy, codependency, Autism may be not covered if over 21.
ID 100129594, quote me the benefits for physical therapy.
covered other than maintenance allow up to 60 visits per c/y for PT/OT/SP osteo chiro if more than one done on same day will count as one visit, evaluations will not count toward maximum. member has not used any visits, may need RX from Dr, subject to $1500 ded, 20% $3500 OOP
Name 2 special groups that do not follow ACA guidelines.
What is Douglas County and Nucor steel,
What 3 types of providers do the ancillary guidelines apply to?
What are independent lab, DME/HME suppliers and specialty pharmacies.