Benefits
What's the difference between Diagnostic and Preventive?
Preventive is a service done to stay healthy - before symptom. Diagnostic is symptom related.
What type of plan is an Exchange plan?
HMO
What tab in facets do we go to check if the plan is active?
Eligibility Tab
These codes represent the procedure done (office visit, surgery, diagnostic service, lab work, etc.)
CPT (Current Procedural Terminology Codes)
What benefit is the Code 73592 under?
X-rays and Diagnostic Imaging benefit
Member ID: 122566544
What's the Original effective date?
01/01/2022
In documenting the eligibility, what subject and category do we use?
Membership Record and Eligibility Inquiry
These codes are used by physicians to identify why the patient went to the doctor
ICD-10 Codes/ Diagnosis Codes
PRODUCT ID: S0MD0020
GROUP ID: MDONEX
What is the benefit for PCP Office Visit?
$0.00 Copay, 0% Coinsurance, Deductible does not apply
This is the amount that the member pays to keep the plan active.
Premium
In documenting the benefits, what subject and category do we use?
Benefits and Medical Benefits
These codes are for medical equipment, drugs, transportation services and other services not covered by CPT Codes.
HCPCS Codes
PRODUCT ID: RGTX0000
GROUP ID: TXONEX
What is the benefit for a Specialist Office Visit
$60.00 Copay, 0% Coinsurance, Deductible does not apply
Member ID: 127270533
Are we the primary insurance of the member? If no, who is?
BLUE CROSS BLUE SHIELD OF TEXAS
What tab in facets do we go to check if there are other insurance?
COB Tab
This is the amount that the member has to pay before the insurance pays anything.
Deductible
What accumulates to the OOP (Out-of-Pocket)?
Copay, Deductible, and Coinsurance
How many months is the grace period?
3 months
2 things we change in facets in the beginning of a call. And what do we change them to?
Customer Type: Provider
Contact Info Type: Provider/Provider's representative
This is a two-character code that we use with CPT or HCPCs Code to give more information (LT, RT, TC, 26, 50, etc.)
Modifier