COB
What COB stands for.
The two plans that require referrals for specialist services.
What are Choice and Connect?
The subject, category and summary needed to log a call where specialist OV benefits were quoted.
What are ExBenefits Med, Specialist Services, and OV?
The in-network diagnostic benefit quote for MBR ID 100205750-00.
What is 20% coinsurance, deductible waived, up to the $6350 OOPM?
The definition of EOP and who this gets sent to.
What is Explanation of Payment and who is the provider?
The department that COB is a subset of.
What is OFT? (Operations Financial Transactions)
BONUS Bragging Points: What are the other 2 sub departments?
The person(s) responsible for submitting a referral on a member's behalf.
What is the medical home?
The benefit quote for an in-network specialist OV for MBR ID 100186712-00.
What is: $10 CP, deductible waived, which applies to the $1200 OOPM?
The CPT code billed indicating venipuncture/blood draw.
What is 36415?
The summary when logging a call about claims.
What is DOS and provider/facility name?
Using MBR ID 100550534-01, tell me what the member's primary MBR ID # is. (Dual member)
What is 100792905-00?
Whether or not family planning requires a referral.
What is no?
Where you can refer a member with questions on PH&S providers or facilities or classes offered.
What is the Providence Resource Line?
The modifier billed indicating where an x-ray was taken. (Where the member physically presented)
What is TC - Technical Compotent?
Claim status 11 and if information can be given on a claim in this status.
What is pended? What is NO?
The name of the primary insurance listed on file for MBR ID 100118445-01.
What is United Healthcare?
The date span listed for MBR ID 112957751-00 and Reference # 180800666.
What is 03/21/18 - 03/21/19?
Whether provider Tiara Packer is listed as a PCP and/or specialist in Facets. (Use MBR ID 113163381-00)
What is specialist?
The modifier billed indicating the reading of the results of an ultrasound.
What is 26?
The payer ID for OfficeAlly.
What is PHP01?
List off the things needed to be included when routing a CSI to the COB team. (Hint: Don't guess, check KMS!)
Go look at the KMS scenario :)
The number of office visits allowed and if any have been used on Reference # 180640759 for MBR ID 112995573-01.
What is 6 allowed and 1 paid?
The specialist OV benefit quote for 100451084-00.
What is CIF after family deductible of $13,300?
What is CIF, deductible waived?
BONUS Bragging Points: What Providence facility offers 3D mammograms?
The amount paid on CL 181085556500 for MBR ID 113066457-00 on DOS 04/12/18 with Dr. Ashok Modha.
What is $135.02?