Auth or Yes
How many procedure codes are allowed in each case?
14 codes
What does the acronym SNP mean?
Special Needs Plan
We don't provide Benefit information for delegated plans?
False
What is the title of the job aid for delegated plans for Intake?
Plans Not Handles by M&R Intake
What is the payer ID to submit claims for WellMed?
WELM2
What is a written order from the member’s primary care provider for the member to see a specialist or get certain health care services?
Referral
In order to take advantage of Medicare, a person must be a U.S Citizen aged 65 or older, Citizen under the age of 65 can also use Medicare if they have a qualified disability.
True
For delegated plans specifically to WellMed , UHC only handled eligibility and benefit. Prior Authorization requirements should be handled by the delegated department.
True
What is the title of the Intake Job Aid for Accelerating a case?
Case Review Acceleration
How long is the benefit period when the member hasn’t been IP at any hospital or Skilled Nursing Facility?
60 calendar days
How many days is retro referral allowed?
5 calendar days from the Date of Service
What part of Medicare combines the Part A and Part B options and optionally provides Part D drug coverage, as well. This is also known as “Medicare Advantage” because, in most cases, it is a lower cost alternative to Original Medicare?
. Medicare Part C
What tool should be used in checking if a certain procedure code was already billed in the past?
CPA
What Intake Job aid title will you check if provider is asking for an observation authorization?
Observation Stay Notifications FAQ
What is the Knowledge Library indicator for services that falls under OP - major diagnostic?
Lab, X-ray, and Major Diagnostics- CT, PET, MRI
How many days do a retro-authorization for IP cases?
93 calendar days from the discharge date
What do you call a code that starts with a letter, followed by two digits, then a decimal which also helps identify why the patient went to the doctor?
ICD
We automatically transfer the provider if the call is for dental benefit
False
What Intake Job aid title will you check if you need to manually route a case?
Intake of Medicare and Retirement ICUE/HSR Work Queues
What is the limited service code used in CPA, in checking the accumulation for routine vision exam ?
41
What should be the correct network steerage if the member is aware that the provider is OON?
Patient Electing to use OON Provider
What is the amount that the member pay for health care services before the health insurance begins to pay?
Deductible
LIS Copay Field in Spire with zero indicator means, we follow the Low Income Subsidy Index?
False
What Intake Job aid title will you check if you will create a case with missing information?
Request with Missing Information
What is the first dollar payment that applies to the allowed amount before the rest of the benefit is calculated?
. Copay