PROVIDERS
Who is one of many sub-specialties of internal medicine and focus on treatment of the heart and blood vessels of the cardiovascular system?
Cardiologist
What tab is the Service/Rule found under?
Line Item pricing
What is a Z91 denial?
Not the member's PCP
Where can you find the exact claim that was submitted to Horizon?
DMS
What state did Stacie say she lived in before Fla?
Michigan
What type of providers bill on a HCFA 1500 Claim form?
Professional Providers
What is the Place of Service code for an Urgent Care Facility?
20
What is a Z55 denial?
provider not payable by contract
What system is used to identify if a CPT needs an authorization/referral?
Look-Up Tool
What is the grad school dean's last name?
Nester
These providers agree to all Horizon admissions to Horizon Utilization Review and abide by our determinations, bill Horizon directly for their patients’ services, and accept our allowance as payment-in-full (under certain circumstances) and seek only to recover any co-payment, and/or coinsurance due (only when applicable).
Par and in-network providers
What status code indicates a "Closed" claim
99
What is an indicator of a Claims Xten denial?
lower case e,f,g,h,i,and j
What system is the main System used to research claims used by Horizon?
Facets
What is the term that April uses when referring to her grandchildren?
Grand Blessings
What type of providers bill on a UBO4 claim form
Facilities
What are the "Core Four" tabs?
Claims information, Disallow amounts, Line Item Detail and Line Item Pricing
Where would you search for an authorization for a no authorization denial?
Prospective UM /history
What is the NJ state system that we can confirm COB status as well as state information on the member?
Emeves
What is Karen's go to dessert for potlucks?
Crock pot Mac and Cheese
Who are medical doctors who treat diseases or disorders of the eyes and perform eye surgery.
Ophthalmologist.
Where is the check cashed date found, what else can be found there?
under the remittance tab transfer to payment information, also you can find payment details and recovery details.
What is this the following denial
Invalid/missing payer control number
correct claim missing original claim number
What system was put in place to allow for the efficient transfer of huge amounts of information from medical providers to health insurance carriers, government agencies, and other health care professionals/organizations and also allows for uniform documentation between medical facilities?
Medical Coding
What is member equivalent to Mrs. April
Angela