Individual
The network Choice members need to use while in Oregon to receive in-network benefits.
What is ProvChoice?
Name three groups who use the FCHN network for in-network benefits while in Washington.
What is Clackamas County, CollegeNET, Columbia Sportswear, OFC, SAIF, School District Trust or Umpqua?
True or False: AIM is a third party vendor who offers discounts for hearing and vision services.
What is False?
BONUS for bragging points - what does AIM actually do?
The name of the network PEBB ProvChoice members use for in-network benefits in Oregon.
What is ProvChoice?
The name of our primary network located in Oregon and SW Washington.
What is the Signature (EPO) network?
Whether or not Dr. Thomas Kasten (99th Ave in Portland) is participating for a member on the Connect plan. Use member ID 113059446-00 if needed.
What is yes, he is participating with the Connect plan - this provider has an active NEIGHBORHOOD network row.
The name of the network member 113184020-00 uses in Montana for in-network benefits?
What is FCHN?
The vendor we transfer to when a member is asking for mental health benefits or how their claim processed after receiving mental health services.
What is PacifiCare Behavioral Health/PBH/Optum?
The name of the extra network PEBB Statewide and SAIF members are able to use for in-network benefits in Oregon.
What is the OHSU network?
In 2019, the name of the network a Cardiologist in zip code 63005 would need to be participating with for member ID 100173560-00 to receive in network benefits.
What is First Health?
Whether or not member 1001777230-00 can see Dr. Ward Carpenter in zip code 90028 for in network benefits.
What is no - Dr. Ward Carpenter is participating with PHCS/Multiplan, but this member is on a Choice plan so they aren't able to use the National Networks.
Name of the network Dr. Zachary Chipman needs to be participating with for member 100217905-00 to receive in-network benefits.
*BONUS* Is he?
What is the PHCS/Multiplan network?
*BONUS* (bragging points) Yes!
The name of the department who handles premium payments for Individual members.
What Membership Accounting?
Use member 100696921-00. The network in Facets used to determine if Dr. Leila Keeler in Hermiston, OR is participating for this member's plan.
What is the PPONOEPO network?
The networks being replaced by the First Health network in 2019.
What is Brightpath and PHCS/Multiplan?
True or False: A visit to the emergency room while in Austin, TX will pay in-network for member ID 113185220-00.
What is True?
Name of the plan type for member 100101439-00 and the reason a claim would deny if this member went to an out of network provider.
What is a personal option plan and no out of network benefits?
This department is responsible for configuring Facets and setting up our provider networks in Facets.
What is Systems Administration?
Whether or not a PEBB ProvChoice member receives in network benefits when they use a Brighpath contracted provider in Southern Idaho.
What is no, this would be out of network.
The name of the network in Oregon a few groups use to receive in network benefits when seeing Legacy and OHSU facilities and doctors.
What is Universal PPO?
Whether or not Dr. Jonathan Crist on Hall Blvd in Tigard is participating for member ID 100962390-00.
What is no, he does not have a NEIGHBORHOOD network row?
What we call the group of other carriers' networks we rent outside of Oregon and SW Washington.
What are the National Networks?
What OFT stands for and the three departments within it (acronyms and definitions).
What Operations Financial Transactions?
COB - Coordination of Benefits
TPL - Third Party Liability
OPR - Overpayment Recovery
The name of the network PEBB ProvChoice members can use in Montana to avoid balance billing.
What is PHCS/Multiplan?
Whether or not the Walgreens at 3101 New Bern Ave in Raleigh, NC 27610 is in network for member ID 100185415-00.
What is yes?