Site of Service
SOS would apply if not addressed.
No/False
Authorization field is marked with Evicore.
Reject
To search you member you must use?
SSN
What do you need for specific services
Benefit coverage, exclusions and definitions
Could CPT 81479 be a fast track?
Yes if doctor is an Ophthalmogist or Urologist
For Med Nec plan what should the product year be?
2019 or newer
Patient Tab has a correct member name but didn't add the middle initial
Not a Reject
You need to run COW for DME?
No
What do you need for general services?
exclusions and definitions.
What states require a peer to peer?
TX, VT, RI
How many miles from the patients home should we search in Amardi?
30 miles
If the NPI is missing
Reject
For Infertility, Sclerotherapy, PT/OT/ST/Chiro must search 1 year from todays date.
No Infertility is lifetime.
What does the asterisk * mean?
Where do you find the AMT list?
In DOC360 under Benefit Documents
Where do you look to see if there is an ASO/NEASO buy-up?
In HSR in the left panel under Eligibility
If Auth Line list all denied codes
Not a reject
You do not have to click on advanced search.
False
What is needed for Breast Reductions>
Specific- Cosmetic , Reconstructive, Gynecomastia, Medically Necessary
When do you use the E&I Benefit Template?
When you have to use BTB/BDR or IBAAG instead of the SPD/COC
Where di you find the Product Year for a Cirrus case?
Contract - Member Group Contract- click magnifying glass - enter Group ID and click filter-click blue link for ID-click preform action -click contract option scroll to like at bottom for ID id Medical Contract option. Click plan option tab scroll to bottom and click on you benefit bundle
If the FLN is requesting reason for denial.
Reject
How do you print results?
Click Copy Results to clipboard and paste it on an excel sheet
What is needed for a hysterectomy?
General - exclusions and definitions
If you have a standard case and an urgent one comes in after but was downgraded which one is worked.