BENEFITS
THIS IS THE FIXED AMOUNT PATIENT PAYS FOR A COVERED HEALTHCARE RECEIVED FROM A PROVIDER
CO-PAY
WHAT IS THE MEANING OF CASE STATUS DC?
ON WHAT TAB ON ISET CAN WE CHECK THE FUNDING ARRANGEMENT OF THE MEMBER'S PLAN?
ELIGIBILITY TAB
WHAT IS THE MEANING OF EOB?
EXPLANATION OF BENEFITS
WHAT IS THE IPLAN INDICATOR FOR PLANS WITH HRA?
2 AND 5
WHERE DO WE CHECK THE BENEFITS FOR PRIME ACCOUNTS?
PASS
IN WHICH DEPARTMENT DO WE REFER THE PROVIDER FOR RADIOLOGY AND CARDIOLOGY AUTHORIZATIONS?
EVICORE
WHAT DOES COB MEAN?
COORDINATION OF BENEFITS
WHAT IS THE MEANING OF EY REMARK CODE?
CLAIM IS DENIED FOR NO ADVANCE NOTIFICATION OR NO AUTHORIZATION ON FILE
WHERE CAN WE LOCATE THE HRA INFORMATION ON ISET?
UPPER RIGHT CORNER OF ISET ; HOVER STAR ICON ; CLICK ON CAMS
WHAT IS THE MEANING OF DME?
DURABLE MEDICAL EQUIPMENT
ON WHAT TAB IN ICUE CAN WE CHECK IF WE RECEIVED THE CLINICAL NOTES THE PROVIDER SENT FOR AUTHORIZATION REVIEW?
NOTES TAB
HOW OFTEN DOES THE SUBSCRIBER / MEMBER NEEDS TO UPDATE THEIR COORDINATION OF BENEFITS ?
ATLEAST EVERY 6 MONTHS OR TWICE A YEAR
WHAT IS THE CLAIM SUBMISSION TIMELY FILING LIMIT IN GENERAL ?
INN - 90 Days from DOS unless otherwise Specified by their contract (Check UNET NDB Screen)
OON - check IBAAG (CTRL F "filing limit" if no results automatic 1 year from the DOS
WHAT IS THE FAX NUMBER FOR CLAIMS MAILING ADDRESS: P.O. BOX 30555SALT LAKE CITY , UT 84130, 0555?
801-567-5498
ON WHAT SECTION IN IBAAG CAN WE QUOTE THE BENEFITS FOR PROFESSIONAL FEES FOR SURGERY?
Physician Fees for Surgical and Medical Services
SRN ( SERVICE REFERENCE NUMBER)
WHAT DOES EPO - EP1 TYPE OF PLAN COVERS ?
INN SERVICES ONLY
WHAT IS THE E-PAYER FOR ELECTRONIC CLAIM SUBMISSION?
87726
WHAT IS THE TIMELY FILING LIMIT FOR CLAIM RECONSIDERATION SUBMISSION FOR INN PROVIDER'S ?
12 MONTHS FROM THE ORIBINAL PROCESSING DATE
ON WHAT SECTION IN IBAAG CAN WE QUOTE THE BENEFITS FOR SPEECH THERAPY SERVICES DONE OUTPATIENT FACILITY SETTING?
REHABILITATION SERVICES (Rehabilitation Services - Outpatient Speech Therapy )
WHAT IS THE PEER TO PEER (P2P) PHONE NUMBER?
800-955-7615
ON WHAT TAB IN ISET CAN WE CHECK THE LAST COB UPDATE ON THE ACCOUNT?
866-230-5783
WHAT IS OPTUM INSIGHT'S MAILING ADDRESS?
Optum Insight Mailing address: PO BOX 740805, Atlanta, GA 30374-0805