This is also known as a TAMI code or an Alternate Type Code
What is carveout?
100
Which tab on the NPD houses the deductibles and out of pocket information?
What is the General Tab?
100
This major med calc would be used on a plan when the deductible reduces the out of pocket
What is a 208 calc?
100
What does TAPS stand for?
What is Template for Automated Prepping and Scratch Loading?
100
On the Record Pointer what does CHIRO always point to?
What is CHIRO?
200
The act of grouping identical places of treatment with matching benefits together
What is lumping?
200
What does NPD stand for?
What is New Plan Document?
200
This calc is used when the benefit takes a specific copayment amount for a specified number of days per admission.
What is an 012 calc?
200
TAPS is comprised of what 2 spreadsheets?
What is TECI and PTCI?
200
On the PMEI screen, if a penny is loaded in a field, then what type of EOB indicator would be used?
What is No Display?
300
Used by Plan Load specialists to indicate a lack of coverage for a particular benefit
What is EX-Invalid?
300
Which typecode will never have a note when in addition to logic applies?
What is XXXXXC (Office Visit)?
300
What type of calc must be used when there is a major medical benefit that requires a copayment, occurrence limit or a dollar limit?
What is Moving Dollar?
300
What cutbacks would a facility benefit use if it is a basic calc less than 100%?
What is None?
300
A 9 would be used in this field anytime there is an amount in the upper right corner on CTCI
What is Basic DED applies?
400
These three screens house the group level information necessary for claims processing. Name the 3 screens
What is PMCI,PMDI,PMEI?
400
What tab will you locate Hospice benefits under?
What is Other?
400
This 2 fields on the CTCI screen must be filled out where there is a visit limit allowed in a specified time period.
What is Occurrences 1 & 2?
400
This field will have an indicator that will be an R for Room and Board typecodes that are taking a copayment.
What is Admit Date?
400
What is the typecode for Surgical Services?
What is OSH?
500
Benefit Category 2 stands for what type of service?
What is physician services?
500
In the NPD there is a column labeled Supplemental Benefits. If this column indicates Yes, where else should you look to make sure this is indicated correctly?
What is Bypass LCD on the TECI?
500
This type of calc is used for facility emergency room copayments
What is a D2 calc?
500
What 2 fields must have an indicator if you have a basic calc that is subject to a deductible?
What is MM Ded Applies and Comp Ded Applies?
500
For physician typecodes where POT V is valid, POT V will used what benefit for par and what benefit for nonpar?
What is Physician Office (POT 3) for par and Freestanding Radiology for nonpar?