Cred Load
What does CONTRT stand for?
Contract
What does RF stand for?
Reference Fee Schedule
True or Fase. Escalators tab in PCON is maintained by Payor Partnerships.
True
Most of our Service Now ticket comes from this team.
Payor Partnerships
What 2 CDMs are in Nautilus but not in PCON?
HD SNF and HDUF SNF
When a ticket goes from CONPEND TO CONTRT, what Reason code should be used?
Explicitly Contracted
How many CDM's do we currently load into PCON?
341
List 3 products that we use under Product Tab of PCON.
HMO_EPO, HOSP_IND, HIS, INDEM, Lease Network, MAASGN,, MCASGN, POS, PPO, PRISON, TRI_CHAM, VA
When we need Sensipar to be supressed a child ticket needs to be sent to this team.
Claim Formatting
HD SNF and HDUF SNF are priced to mirror what two CDMs?
HDH and HDUF
True or False? When a facility goes to CONPEND there needs to be a fee schedule listed.
False
What reference fee schedule does fee basis Medicare use?
RF_MCARE
What drug is uses HCPC J0604?
Sensipar
After QA, CM sends tickets to this team for claim corrections.
RM
What CDM uses HCPC code J0606?
ETEL
When a Lease Network becomes contracted what Financial Class should be used?
Optcon
True or False? Sensipar is always priced as Pharmacy Benefits in Commercial products.
False. If it is called out as Included in Treatment in the contract it will be priced as Included in TX.
What basis should be used for BAAB A, BEAB A, CIAB A, and CIAB A2 for a Medicaid product?
RF_ANTIBODY
When building a new contract, a child ticket is created for this team so that a plan codes can be created.
Plan Management
How many CDMs are listed for Oral-Phosphate Binders?
18 CDMS
True or False? NO fee schedule is needed when a facility gets updated to OPTCON.
True
Which drug type always has a AX modifier?
Binders
Name 3 Databases we use for our work.
QA Database, BBQ Queries, LH QA, FS Updates, MINE, FPR Tracker, BS_PSC_Plans Database, New_CDM, NEW NS Data_v3
What team does Mark Notify when Calcimimetics and/or Binders are being updated from SSP $0 or DVA Do Not Provide to an actual price or vice versa?
Clinical Team
What CDM is FVCA10 set to mirror?
FVCA8