TERMINOLOGY
What does CPS stand for?
Claim Payment System
On the MEMBER DISPLAY screen, what dependent number always represents the subscriber/member?
00
What box number will you find the diagnosis code billed by a physician on a HCFA?
1a
What is the description of CPT code 90834?
Psychotherapy, 45 minutes with patient
What does status -40 represents?
retired
An eleven digit number assigned to all claims before they can be processed.
CCN/ claim control number
What does EE Status Code 10 indicate?
active
What should you do first when you need to research a claim-processing question in Knowledge Central?
Search using specific keywords
What box number will you find the member ID in on a UB?
box 60
which sub tab can we check if there is other insurance for the patient?
other insurance tab
These are numeric codes in claim payment system that indicates a charge or entire claim is not eligible for payment.
INELIGIBLE CODES
The screen that finalizes the processing of a claim.
CLAIM RELEASE SCREEN
If the place of service on HCFA is “02”, indicating telehealth, what POS value is used in CPS?
POS 01
USE THE POS/TOS PSD
The total payments toward eligible expenses that a covered person funds for him/herself and/or dependents (i.e., deductibles, copays and coinsurance) as defined per the contract is referred to as what?
OUT OF POCKET LIMIT/ MAX OUT OF POCKET
What is the GEHA group #?
76416933
this database contains a condensed, but detailed overview of the plan. You will be able to answer the majority of your questions by referencing this database rather than, accessing the actual SPD
health plan database/ HPDB
Each claim control number is divided into four segments: 25 011 09 4544
what does 09 represents?
The 6th and 7th digits represent the reel numbers for this document or how the claim was received.
If the reel number is between 10-69, it is an electronic claim.
Which claim form generally represents a professional claim?
HCFA/ CMS-1500
What is the primary diagnosis code on this claim? and what does it mean?
Z38.00 Z38.00 Single liveborn infant, delivered vaginally
What box number will you find the member ID in on a HCFA?
1a
The total payments toward eligible expenses that a covered person funds for him/herself and/or dependents: i.e., deductibles, copays and coinsurance- as defined per the contract. Once this limit is reached, benefits will increase to 100% for health services received during the rest of that calendar year..
max out of pocket/ out of pocket limit
What box number will you find the diagnosis code billed by a physician on a HCFA?
21
WHAT IS THE DESCRIPTION OF C-AP1 WHEN ENTERED IN THE BLX PEND MESSAGES SPREADSHEET?
What is the correct place of service for this claim? use the UB Logic PSD
02/03- inpatient
What is the OPI for this Plan?
GUC/ GEHA_UNITEDHEALTHCARE_CHOICE_PLUS