OP Rehab
The 3 types of services related to outpatient rehabilitation.
What are physical, occupational and speech therapy?
Which benefit a glucose monitor falls to. (DME or diabetic supplies)
What is DME?
What type of DME L codes are for.
What are prosthetics and orthotics?
The department responsible for reviewing submitted prior authorization requests.
What is HCS?
Denise's favorite restaurant.
Whether or not a referral is required for OP Rehab for Choice/Connect plans.
What is NO?
The location code billed indicating a provider's office.
What is POS 11?
Whether or not E0170 is a payable code (Office or DME vendor).
What is NO?
BONUS Bragging Points: Who does it deny to?
Whether or not a PA is required for 42226.
What is yes?
The name of a form someone can fill out to give access to their account to someone else.
What is a consent form?
How many 2018 OP rehab visits have been used for MBR ID 113263197-02.
What is 13?
The location code billed indicating the member's home.
What is POS 12?
Whether or not a PA is required for code A4290.
What is yes?
Whether or not a PA is required for 95869.
What is no? However this is not a guarantee of payment, and all services are subject to medical necessity, eligibility at the time of service, and cannot be cosmetic, experimental or investigational and are subject to plan exclusions.
The tool where notes from nurses in case management are housed. (Also where information about partially denied PA's are)
The OON benefit quote for OP rehab for MBR ID 100426853-00.
The vendor responsible for DME distribution for our members in Oregon and SW Washington.
What is Providence Home Services?
Whether or not a PA is required for code J0606.
What is no? (As of 04/01/18)
The amount of time that HCS has to review prior authorization requests.
What is 2 business days?
Whether or not PA/Ref # 180860054 was approved or denied for MBR ID 100747064-00.
What is denied?
The in-network benefit quote for OP PT for MBR ID 100742905-00.
What is 30% coinsurance, deductible waived, up to the $5000 OOPM, limit of 30 visits combined with OT/ST?
Whether or not Evergreen Prosthetics and Orthotics (Oregon City) is INN or OON for MBR ID 113263197-00.
What is yes? (Providence Home Services subcontractor)
Whether or not a member can obtain code E2326 from a provider's office or not.
What is NO?
BONUS Bragging Points: Who does it deny to?
Whether or not a PA is required for something on the focal group list (requiring PA) if PHP is secondary for the member, and their primary insurance does not require a PA for the service.
What is no? (We follow suit with what the primary insurance requires or does not require)
The CPT code approved on PA/Ref # P259601 for MBR ID 100834638-00.
What is CPT code 19318?