KB Articles
KB 102017 is for?
Appeals and Grievance
What is complete plan disclaimer for HMO?
As authorized by Medical Group...
Authorization request for Sleep Studies and Radiation Therapy will continue to go through?
Evicore
On what box we can locate the TOB for UB-04 claim?
Box 4
What tool is used to check rejection reason of a paper submitted claim?
Emdeon
What is the KB article for California Resource List?
KB 95473
It is a verbal or written request by the caller to overturn a denial, modification, or delay of a determination made by Health Net, delegated vendor, medical group, or the member’s provider.
Appeal
The following imaging procedures require prior authorization through?
CT/CTA,CCTA,MRI/MRA,PET Scan,(MPI),Muga Scan,Stress Echocardiography,Transthoracic Echocardiography (TTE
NIA, per KB 112382
If the claim was billed with Place of Service 21, it means the claim is?
Inpatient
Omni 1 member is checking the status of her appeal, what tool to use?
MACESS
What is the KB article for Eligibility Disclaimers?
KB 111723
Is a request to file a complaint with the plan that would require a written response.
Formal Grievance
What prompt in ABS we have to use if we want to check if the code needs an authorization?
Which workbasket do we route an escalated claim for OMNI 2.0
CNC_ClaimsEsclations_WB, KB 120452
If we would like to check enrollment documents for OMNI 2 members and claim images of paper submitted claim, what tool to use?
Filenet
KB 113121
Refers to the quality of medical care received by the member. If the issue reflects that the member perceives the services or lack of services are having negative effects on their health.
Quality of Care
What is the correct and complete address for Medicare Claims?
PO Box 9030 Farmington MO 63640
What tool to use to check ERAs?
PaySpan
By checking this KB article, we will know that AT&T is handled by dedicated team.
KB 90582 or KB 112160
What is the complete disclaimer for OON provider?
“As a reminder all claims are processed at the Maximum Allowable Amount, the member is responsible for any deductibles, copayment/coinsurance and anything exceeding the Maximum Allowable Amount”…
Using ABS, what prompt to use in checking authorization status?
MDMAUTINQ
What is the TAT for submitting a new day claim for an INET provider?
120 calendar days
What is the complete web address to check for authorization in OMNI 2?