WHO?
A DSNP PLAN SNF AUTHORIZATION
NAVI HEALTH (FORMERLY KNOWN AS NAVI HEALTH)
CMS
Centers for Medicare/Medicaid Services
MEDICAID INN ORIGINAL CLAIM
INN Providers have 180 days from the date of service to submit an original claim, unless the contract states otherwise.
MEDICAID MEMBER CALL
866-292-0359
INC TICKET
FOR AN OUTAGE
CLAIMS FOR A MEMBER IS HOSPICE
ORIGINAL MEDICARE
PA
PRIOR AUTHORIZATION
DSNP INN CORRECTED CLAIM/RECONSIDERATION
INN providers have 1 year from the original denial / processed date to submit a corrected claim or reconsideration, unless the contract states otherwise.
DSNP MEMBER CALL
844-368-6886
USE FACETS
CHECK PREVIOUSLY BILLED CODES, FEE SCHEDULES, LOTS OF THINGS
MEDICAID MEMBER--PRIOR AUTHORIZATION FOR CPT 70450
EVICORE
PRA
Provider Remittance Advice
MEDICAID OON APPEAL
Providers have 90 days from the last adverse decision date to submit an appeal, regardless of network status.
EVICORE
866-889-8054
LOOK IN ECHO
IF THE CLAIM IS STUCK IN PENDING IN THE CLEARINGHOUSE
DSNP SECONDARY CLAIM
STATE OF MISSOURI
CPT
Current Procedural Terminology
SUBMIT PRIMARY EOB
All providers have 1 year from the date the primary insurance processed the claim to submit said claim to United Healthcare with the primary's EOB.
SOURCE CODE CO
EITHER UNIVERSAL IN IVR OR 800-227-7789
USE MACESS
NEVER... DONT THINK YALL EVEN HAVE ACCESS
PRIOR AUTHORIZATION FOR HCPCS CODE H0015
BH
HCPCS
Healthcare Common Procedure Coding System
PRIOR AUTHORIZATION APPEAL
60 days from denial date
OPTUM R DENIAL
800-864-9084
DO A RECONSIDERATION
PROVIDER DISAGREES WITH DENIAL