Claims1
claims used by facilities
UB-04 form
claims filed by professionals/individual providers.
CMS 1500 form
What should the provider submit if they have errors in their diagnosis codes?
Corrective claim
Which plans do not require referrals?
EPO/PPO plans
How many hours does it take for a claim to reflect in the system when they sent it electronically?
24-48 hrs
Electronic Payor ID of Optum
87726
What should you do if the provider doesn't want to submit a formal dispute?
Escalate to Claims Team
If the date of service is January 04, 2023, what reimbursement policy should we refer to?
2023 Oscar IFP/SG Reimbursement Policies
What referral should an HMO Individual Plan MM must obtain from their chosen PCP before seeing a specialist or another doctor within the same network?
Insurance referral
If there are more than 10 claims, we advise the provider to submit a _ to providerrelations@hioscar.com
spreadsheet
If we don't have the Claim ID, we can pull up the member's claim using _ and _.
Service Date and Original Billed Amount
If the provider submitted the claim through Certified Mail, what should we ask them to locate it?
Tracking Number (USPS Website)
What keyboard shortcut should we use to locate the codes in the reimbursement policy?
CTRL + F
A standing referral can last up to _
6 months
_ status does not necessarily imply that Oscar is paying something on a claim.
PAID
Where can the providers submit their external appeal after they exhausted the dispute process internally?
to their respective State Regulatory Body
What is the fax number we use to submit claims?
None
If the PR is not satisfied with our response or requires a more detailed look into the contract or fee schedule, we can set the ticket status to _.
Waiting on Provider Relations
In Illinois, if MM’s PCP is not available, referral can still be provided by an INN PR as long as they the same _.
TIN
If the Allowed Amount is $325 and Oscar pays $128.72, how much is the mm's responsibility?
$197.28
What is the payment method used for the claim with charge group ID 12014438?
ACH
What is the timeframe for providers in Ohio to submit their claims in 2023 for it to be not denied for timely filing?
180 days
What should the provider click if they want to check the reimbursement policy for Chest X-ray with CPT Code 71045 that was rendered on 2024?
Under Evaluation and Management Services
OBGYN services can be done to a mm by the specialist because it is an example of _.
“Services Not Requiring a Referral”