Be InSPIRE
Where can we see the provider Group Name?
Policies Details.
This kind of services always require notification.
Inpatient Services.
Is it true that Medicare plan is fully funded?
Yes. Medicare is fully funded plan.
This tool is our guide to transfer the provider that is out of our scope.
Redirection Tools.
Using redirection tool, what should we select first before we can see where to transfer the chat?
Click to Chat
To what card we can check if prior authorization is required.
PA Check
In quoting Inpatient Benefits, what should we search or select on the benefit details card if they are checking for Inpatient Hospital coverage?
Hospital - Inpatient Stay
Inpatient Hospital and Related Services
Can you identify the tool where we can check CPT or HCPC codes and its description.
Knowledge Library
Using Provider Notification List, what should I select if I am checking a CS service code plan.
Advocate should pull up the tool and walk as through what to select.
To what card we can see the member's information such as member date of birth and member ID.
Member Details
What probing questions we should ask the provider if they are checking for Inpatient Benefits?
Is this for facility fee or professional fee?
In Medicare, what plan type do not have OON coverage with the exception of emergency.
AARP Medicare Advantage (HMO Plan)
Share the tool that we use to check if an authorization is required.
Using Spire, can you walk us through where we can search the member benefits?
NPI: 1063892354
Provider’s Name: TUL SI ROY
Member ID: 992436648
Member Name: JUSTIN HUFFAKER
DOB: 08/14/197
Advocate should share her/his screen and walk us through and locate the correct card (Benefit Details).
Using Spire, can you pull up this member and tell us where to find the payer ID and claim address.
NPI: 1093756645, ALAN HALL, 201 S OAKRIDGE DR, HUDSON OAKS, TX,76087
Member ID: 980377900, ALAN H MARTIN 11/16/1948
Under Policies Details, click View Member ID card. Then, at the front you can see the Payer ID: 87726
At the back is the Medical Claims: PO BOX 31362 SALT LAKE CITY, UTAH, 84131-0362
It's a requirement that physicians, other health care professionals, non-facility providers, or facilities notify us before performing services related to certain services or procedures.
Notification/Authorization
What should we select in the Provider Notification List if the provider is checking a Medicare plan.
UnitedHealthcare M&R / Medicare Advantage - Including C&S Duals & West
HIPAA Confidentiality Reference Tool
On this tool, we can see the lists of the CPT/HCPC code range.
Claims Codes and ICES - Code Types