Animals
This is the only mammal that's capable of true flight (without an airplane!)
What is a bat?
This is the hottest planet in the solar system.
What is Venus?
This is what you do if a Medicare Crossover has denied for timely filing, but it's been less than 90 days since Medicare paid.
What is complete a claim escalation?
If a member has Part B Premium only, the provider should be advised this for Edit 101 (No Active Provider Contract)
What is the denial is valid?
You need to check these to determine the reason for Edit 225 (Contract Term Requires Manual Review).
What are memos/attributes?
This is the only place on their body that dogs have sweat glands.
What is the pads of their paws?
An astronaut dropped this item while on a space walk outside of the International Space Station in November 2023.
What is a tool bag?
This is where an out of state provider needs to email if they need to see an Ohio Medicaid member.
What is medicaid_provider_update@medicaid.ohio.gov? (For assistance on single case agreements)
For Edit 201 (No enrollment exists for claim start date) you go here to determine if the member has active coverage.
What is Member Eligibility and then Benefits?
A provider usually has an issue with the way the member is loaded here (hint: 99% of the time providers use one of these) with Edit 6143 (EVV - No Match Found).
What is a clearinghouse?
This is what a female fox is called.
These were the first living creatures in space.
What are fruit flies?
We do this with MD AP Credit Memos on AR Invoices in Finance.
What is complete a Finance Escalation to Amanda Hazlett?
For Edit 608, UM is Not for Same Provider, you will do this research.
What is check the authorization and confirm that the correct provider is shown on the authorization and the claim?
If you see Edit 525 (Diagnosis Code is Not Valid on DOS), check this.
What is the diagnosis code effective/term date in VUE360?
This is the closest living relative to the T-rex.
What is the chicken?
This is the year that Halley's comet was last seen in Earth's skies.
What is 1986?
This is what you should advise if asked if a parent can be the home health aide for a minor.
What is no? {Home health aid services: Are performed within the home health aide's scope of practice as defined in the 42 C.F.R. 484.36 (October 1, 2016). The home health aide cannot be the parent, step-parent, foster parent, or legal guardian of an individual who is under eighteen years of age, or the individual's spouse.}
You should do this to verify if Edit 205 (Edit Requires UM) is a known issue versus a valid denial.
What is check the CPT code to determine if it requires a prior authorization?
For Edit 6269 (FQHC RHC Ordering Provider Required), you need to check the providers section of the claim for this.
What is to determine if there is an ordering provider listed?
This is the only big cat that doesn't roar.
What is a cheetah?
The Voyager 1 probe was launched in 1977 and contains this from the people of Earth.
What is a phonograph record with images and sounds of the planet Earth?
This should be advised if a provider needs more units on the authorization.
What is the UM (utilization management) team cannot change the number of requested units. Please advise the provider to cancel/end date the current authorization and submit a new one?
For Edit 611 (No Available Auth Units), you need to check the authorization for this.
What is the amount of approved service lines and approved units?
If you see that the contract term is termed when doing your research for Edit 376 (Contract Term Restriction Group Validation), you should do this.
What is complete a claim escalation?