Clark County
True Or False
When an employee hits age 65 they MUST apply for medicare.
True
905
905-Charge(s) denied. Claim filing exceeded timely filing requirements for the contract. Provider may not bill you for this amount.
Provider calling to verify they are INN or OON for a PPO Clark County member who resided in Nevada.
STEPHEN WOLD
9090 W. POST RD., #100
LAS VEGAS, NV 89148
INN
7K
Amount of Optum Health Behavioral claims only applied to combined deductible
Blood Pressure Cuffs/ Monitors
on 'Covered/ Excluded Services'
MID 354000605051
What is the members Tier 2 Ded? What outpatient services apply to this ded?
$250--Deductible is waived for most Tier 2 physician charges.**The following physician services will apply the in-network calendar year deductible of $250.00: Acupuncture, chemotherapy, Chiropractic Care, Home Health Care, Hospice Care Services, Orthotics, Prosthetics and TMJ Benefits.
what needs done for codes 368 & 369.
This is a CES edit which needs appeals with medical records.
Provider calling to varify they are INN or OON for a member who uses UHC Choice plus
Richard William Farnam
4505 N Mesa St
El Paso, TX 79912
OON at that location
PN
Skilled nursing max
Custodial care
Covered/Excluded Services – Custodial Care
is there a penalty for no prior auth?
Failure to obtain precertification will result in no coverage for All Related Charges (includes all ancillary services).
005
005-Charge(s) denied. Need Medicare Explanation of Benefits. If necessary, request new copy from Medicare and send for consideration.
Provider calling to varify they are INN or OON for a member who uses UHC Choice plus
TUDOR JIANU
6 STEPTOE CIR.
ELY,NV 89301
ONN
RK
Deductible
Outpatient birthing centers
Pregnancy
What are 2 reasons a PPO plan needs to fill out COB form?
-Spouse is self-employed (they need to check self-employed box on the form and submit)
-Spouse is employed – if the spouse is employed and they include the cost of coverage under their employment and do not elect that coverage a rate form is no longer required by the group.
252
252-Charge(s) denied. Inpatient benefit maximum has been met. Refer to Schedule of Benefits in your Benefit Booklet.
Provider calling to varify they are INN or OON for a member who uses UHC Choice plus
ANNA RUTH KENT
214 Peach Orchard Rd, McConnellsburg, PA 17233
and
626 Water St Ste , Orbisonia, PA 17243
INN at McConnelsburg location
OON at Orbisonia location
MMNAE
Major Medical Non-accident Emergencies
Shingles Vaccine
Routine Care > Immunization > review the HCR vaccine list linked in this tab
If there is no out of area approval on file, what form should
be offered when the dependent resides outside of Nevada and the policy
holder resides in Nevada?
Guarantor/Student Affidavit Form
what do we need if we see code 546
Only for use when medical records are needed for retro authorization.
Provider calling to varify they are INN or OON for a member who uses UHC Choice plus
TUDOR JIANU
6 STEPTOE CIR.
ELY,NV 89301
OON
IC_VMX_MMMCH
I = Individual
C = Calendar Year
VMX = Visit Maximum
MMMCH = Major Medical Mental and Chemical Dependency
Skilled Nursing
Extended Care