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 for a PHS OR member. (DME or diabetic supplies)
What is DME?
What type of DME L codes are for.
What are prosthetics and orthotics?
The in-network diagnostic benefit quote for MBR ID 112905302-00.
What is Ded waived, 20% coinsurance up to the $6350 OOPM?
$93.69 met towards the OOP max
The names of Tracy's boys and the name of Brooke's dog.
What are Luke, Jace and Mika?
Whether or not a referral is required for OP Rehab for the ProvChoice plan.
What is No?
The location code billed indicating a provider's office.
What is POS 11?
Whether or not E0170 is a payable code for a Columbia Sportswear member (Office or DME vendor).
What is no?
BONUS Bragging Points: Who does it deny to?
The CPT code billed indicating venipuncture/blood draw.
What is 36415?
Two pieces of information that can be given to a Subscriber when they don't have consent and are calling on another adult on the policy.
What are:
Member responsibility, Paid amounts, ID/Group #, Order ID card, Par provider names , Give/Confirm DOB or address, Eligibility, General benefits & total Accumulator, Give/Confirm Employer/product, Give/Confirm COB info, Disenrollment inquiry/reason for term (subscriber only), Premium inquiry (subscriber only)
How many 2018 OP rehab visits have been used for MBR ID 100715395-04.
What is 23?
The location code billed indicating the member's home.
What is POS 12?
Whether or not a PA is required for code A4290 for a School District Trust member.
What is yes?
The modifier billed indicating where an x-ray was taken. (Where the member physically presented)
What is TC - Technical Component?
The type of deductible where both in and out of network services accumulate together in "one bucket".
What is a common deductible?
The in network outpatient physical therapy benefit quote for MBR ID 112854155-00.
What is:
$1350 Deductible, 5% Coinsurance up to $2100 OOP Max
No visit limit on PT/OT/ST, nothing met towards the ded or oop max
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 for a PHS OR member.
What is no? (As of 04/01/18)
The modifier billed indicating the reading of the results of an ultrasound.
What is 26?
The address a participating Premera provider would send a claim to for a PHS WA member who received services in Montana.
What is:
Blue Cross Blue Shield of Montana
PO Box 4309
Helena, MT 59604-4309
BONUS: What prefix should be added to the member ID number?
When a PHS WA member has outpatient PT/OT/ST services, this is the one diagnosis if billed on a claim that does not count towards the outpatient rehab visit limit.
Hint: KMS
What is a claim billed with an autism diagnosis?
Whether or not Evergreen Prosthetics and Orthotics (Oregon City) is in network or out of network for MBR ID 112892375-00.
What is yes? (Providence Home Services subcontractor)
Whether or not a PEBB Statewide member can obtain code E2326 from a provider's office or not.
What is no?
BONUS Bragging Points: Who does it deny to?
The in-network benefit quote for a 3D mammogram for member 100710033-00.
What is CIF, deductible waived?
BONUS Bragging Points: What Providence facility offers 3D mammograms?
What is a reason code?