Claims
This is the number of calendar days that a participating provider has to submit for a claim Reconsiderations or Claim Dispute.
What is 90 days?
Documentation for this should be completed with in 5 business days.
What is an interaction?
This Provider Operation Service Now Request Type can assist with submitting for a term reversal for a provider.
What is Terminations?
This recognition program was development to identify medial practices that have invested in a model of care that puts patients at the forefront.
What is Patient-Centered Medical Home (PCMH)?
A provider is deemed to be contracted as PCP or a specialist with this specific code in Portico.
What is Hat Code?
This line of business will have 'MP' in the plan indicator position of a claim. Which is the fifth and sixth digits of a claim.
What is Ambetter/Marketplace claims?
Example: Y024MPE77388
This is the only line of business that can be submitted in P360 to request for configuration updates.
What is Medicaid? (Sunshine)
This Service Now request allow the PE rep to gain further explanation around crosswalk claims processing, down-coded claims and vendor overpayment project details and payments.
What is PIO Solutions and Support Request?
Or What is Payment Integrity?
This system allow PE to submit Claims MPIP provider concerns to be reviewed by an analyst.
What is P360?
Portico can time out due to inactivity. When this happens, the user may see an error message. Selecting these options from the main screen allows the user to log back in without having to close the entire app.
What is File and Login?
- or What is Login?
Providers can submit appeals for this specific line of business for claims disagreements to PO Box 3070 in Farmington, MO.
What is Sunshine Health Appeals? (MMA, LTC, CWSP, SMI & CMS)
Leaving this field to the defaulted 'NO' option when creating an issue ticket in P360 indicates that the ticket should be shared with external contacts through an automated email.
What is Internal Ticket?
This Provider Operation Service Now Request Type is for when the provider states they never received a payment and ask for an offset.
What is Void and Reissue Check?
This fee schedule is used to base MPIP rates off.
What is Medicare Fee Schedule.
This provider type will always show a blank attribute field in Portico.
What is Group Practices provider types?
Provider can submit this request, with supporting documentation if they disagree with the 1st level outcome/ claim assessment.
What is 2nd level Appeal (Dispute)?
This interaction type in P360 is used to document for assistance with Medical Records (chart chase).
What is Provider Relations Transactional Visit?
This request type to assist with recouperation provider concerns was thought to go through P360 but in March 2025 Provider Operations Dept confirmed that those request would stay in Service Now.
What is Negative Balance/Recoupment/Recovery Issues.
Daily Double: For 800
This formula is used to calculate the MPIP Rate.
What is Medicare rate - 2% sequestration = MPIP rate.
Provider pricing/payclass must be less than 167% of Medicaid fee schedule. Anything higher will not see the increase for MPIP.
This status code in Portico indicates contracted fee as an alternative to the Non-Participating (NP) status code to allows plans to pay providers at the contracted rate and apply rules as if the provider were participating.
What is CF Status?
This screen in Amisys allow the user to locate any Project numbers (PROJ-#) associated with the claim.
What is Remarks Inquiry? or
What is Screen RM0100?
This type of appointment documentation is used for internal meetings regards a provider, i.e., prep meetings or meetings based on an issue the provider is presenting.
What is an Activity?
This Service Now request can be used when there are bio-pharmacy issues or concerns with claims denying for NCH/Evolent Auth issues.
What is CPS PA Operational Excellence Escalation Form?
This system allows PE to submit for MPIP loading issues for when practitioner is not loaded with PCMH status and needing a data maintenance request.
What is CenProv for MPIP Loading issues?
Double Jeopardy: For 1000
These 4 directory resources are impacted when the provider is showing Excluded from Directory in Portico.
What is Ambetter Guide, Printed Directory, Find-a-provider tool, and OMNI?