Benefits
Claims
Knowledge Article
Primacy
100

What is the PAR outpatient MRI benefit for member on SF Case: 09484780

What is 20% of the EC no deductible.  

100

What services were billed on CID: 25059E0018524

What is a CPT: G0101  - Well-woman exam

100

What is the KA # for the benefit disclaimer? 

What is KA 11256

100

What is the primacy for ID: F00003174266102

What is 1' - R000084565365
            2' - F00003174266102

200

What is the NON PAR outpatient CT scan benefit for member on SF Case: 09482681.

What is 40% of the EC + deductible + tax + the difference between the EC and the TC.  

200

What services were billed on CID: 24016E0012251

What is CPT 99214 - office visit 

200

What is the KA # for quoting cataract surgery?

What is KA 7505

200

What is the primacy for ID: H00000080135900

What is 1' Medicare AB
            2' HMSA

300

What is the benefit for OOS outpatient mental health - office visit for member ID: R000014901607

What is $12.00 + tax. 

300

What is the check# for CID: 24094E0025425

What is 1974565.

300

What is the KA # to update OC information

What is KA 7965

300

What does MSP stand for and what KA# that contains this information? 

What is Medicare Secondary Payment. KA 9608

400

If primary plan has a chiro rider (not ASH) and secondary has is an EUTF Chiro rider, would plans coordinate? 

What is NO, per KA 5910
"There will be NO chiropractic coverage coordination under the EUTF medical plans with the EUTF ASH chiropractic rider." 

400

What is the modifier on CID: 25305E0006863. What KA is would you find that information on? 

What is ...
This part of the service involves a professional person’s judgment (e.g., radiologist, pathologist) to interpret the data/report (generated by the test), KA 000005727 

400

What is the KA # for EUTF Active chiro coverage?

What is KA 5910
400

What does OBD stand for? What KA # is this information on? 

What is Order of Benefit Determination. KA # 9607.

500

what is the coverage code for metallic PPO platinum plan? What is the knowledge article #? 

What is 960, 961, and 962.  KA # 9477

500

What is the DCN# for CID: 25296E0028816.
How was this claim submitted?  What knowledge article can you find this information on? 

What is DCN: P15296714802, crossover submission, KA 6924

500
Is a doula an eligible HMSA provider? what KA # did you get this answer from? 

what is No, they are ineligible.  KA # 17875

however on 01/01/26, apple will be covering doula services outside the standard medical benefit structure. 

500

What is the birthday rule? When is it applied? What is the KA #? 

What is ...
The Birthday Rule states that:

  • The parent who has the earlier birth month and day in the calendar year is primary for the children
  • If both parents have the same birth month and day, then the plan that has the earlier effective date (for the subscriber of the plan) is primary
  • KA # 10106