Abbreviations
PL1C
What is Provider Level 1 Coding?
This software edits.
What is Cotivity?
What is reviewed as part of an appeal?
Services received when a member is admitted to a hospital or non-hospital facility as a registered bed patient
What is inpatient?
This is made on a denial of a noncertification/denial based on medical necessity.
What is an appeal?
ASO
Nationwide release of Information (ROI) used to retrieve medical records, claims and access images.
What is Doc Request? (FileNet is also acceptable)
Member level 1 appeals timeframe
CPT is known as _______
What is Current Procedural Terminology?
What is a grievance?
QOCC
The system you use to request records from an out of state provider.
What is PlanConnexion? (What is Blue Squared is also acceptable)
The provider has this long to submit the appeal from the date of notification that it has been denied.
What is 90 days?
ABN, also known as waiver of liability.
What Advance Beneficiary Notice?
A process where BCBSNC gives a provider the authority to perform a health care service on its behalf
What is delegation?
SCCF
What is Standard Claims Collection Facility?
Main resource system for claims.
What is Facets?
If an appeal is determined to be expedited, it is also considered _______.
What is "urgent"?
Urologists, Gastroenterologists, Neurologist, Cardiology.
What is a Specialist?
A single, well defined version of all the data entities in an organizational ecosystem
What is a "Golden Record"?
ERISA
What is Employee Retirement Income Security Act of 1974?
This is the lab portal.
What is Avalon?
Number of days an appeal analyst has to complete on expedited appeals
What is 3 days?
Patient registration for a service or procedure
What is the starting point of the revenue cycle?
A population health management program that adds disease management services to groups of 100+.
What is Engage Health?