Authorizations
Where is the first place we should look to see if authorization is required?
The Focus Chart
What does claim status "02" mean?
Accepted; Batch Completed
That is was submitted electronically
CST
Customer Service Task
What is the subject/category for a call where we helped find an INN provider for a member.
Provider
Search: is provider in network / Search: other
Does CPT 0692T require PA?
Yes
What does claim status "11" mean?
Pended; Awaiting Batch
How many claims images are there for Member ID HT201N2B
24
TAT
Turnaround Time
Under which category would you find "Sleep Study"
Diagnostic & Imaging Services (Lab & X-ray)
Who reviews PAs for CPT 72191?
Evicore
If a claim denies with a Clinical Edit denial, can we send it back for adjustment?
No
What is the maximum amount of results Content Manager will show at one time?
250
EFT
Electronic Funds Transfer
A provider is calling, where do you document their NPI or Tax ID?
Under SSN/ID
What is the expedited turnaround time for an authorization?
72 Hours
If an INN claim processed OON, can we send the claim back for adjustment?
Yes
What three things can we use to search for a claim image in Content Manager?
Claim ID
Document Reference Number
Subscriber ID
DX
What is the subject/category for a call inquiring about coverage for a vision exam.
Vision Benefits
Exam
Is this a funded pairing?
CPT 40650 / DX K14.0
No
What should you do if you see the denial:
84M - DMAP Registration Required for Payment
Obtain the NPIs that were included on the claim and verify them in MMIS.
What can we use to search for claims received on or around a specific date?
Advanced Search
DME
Durable Medical Equipment
What should you do when a caller provides their SSN?
Mask the call