MHS
ME1088
WHAT PLAN CAN WE CHECK ON EPACES
MEDICAID
NAME 2 SERVICES WE PRE SCREEN IN PEGA
ELECTIVE
OUTPATIENT
NAME TWO TYPES OF PAYMENT MENTHOD FOR PROVIDERS WHEN A CLAIM IS PAID
EFT,CHECK
HOW MANY DATA POINTS DO WE ALWAYS VERIFY FROM THE CALLER
3
SCREEN WE USE TO MANUALLY CHANGE A PCP
ME1014
WHERE CAN WE CHECK THE MEMBERS BENEFITS?
TRAILBLAZER
THE PROCESS WHERE A VERBAL CONVERSATION BETWEEN PROVIDER AND CM TO DISCUSS DENIAL OF AN AUTH
PEER-TO-PEER
THIS IS WHERE WE CAN SEE CPT CODES AND RESON FOR DENIALS
LINE ITEMS
HOW LONG CAN A PROVIDER PLACE US ON A HOLD BEFORE WE CAN TERMINATE THE CALL
3 MINUTES
SCREEN WHERE WE CHECK THE LAST UPDATE OF PCP
ME1083
THIS IS WHEN A MEMBER HAS ANOTHER INSURANCE
COORDINATION OF BENEFITS
HOW MANY DAYS CAN A PROVIDER SUBMIT AN APPEAL FOR AN AUTHORIZATION?
60 DAYS
HOW MANY CLAIMS CAN WE HANDLE PER CALL
3
THIS DEPARTMENT IS OUR TRANSLATOR
TRANSPERFECT
SCREEN WHERE WE CHECK THE DESCRIPTION AND LIMITATIONS OF A CPT CODE
RF1031
WHERE DO WE DOCUMENT IF NO ACCOUNT WAS PULLED UP USING THE TAX ID AND NPI?
NEW PROVIDER PROSPECT
TOOL WHERE WE CAN CHECK THE STATUS OF THE APPEAL FOR AN AUTHORIZATION
ONBASE
HOW MANY DAYS IS THE TAT FOR PENDING CLAIMS?
30 DAYS
OUR KNOWLEDGE CENTER TOOL
EGAIN
SCREEN WHERE WE CHECK THE LIMITOF BENEFIT
SAMPLE: ANNUAL PHYSICAL EXAM/ PHYSICAL THERAPY
ME1043
THIS PERSON HANDLES THE PROVIDER'S CONTRACT
NETWORK ACCOUNT MANAGER
IF AN APPEAL WAS DENIED FOR AN AUTHORIZATION, WHAT IS THE NEXT STEP FOR PROVIDERS IF THEY WANT TO FURTHER DISPUTE?
EXTERNAL APPEAL
WHAT ARE THE 2 CLAIM FORMS?
PROFESSIONAL, INSTITUTIONAL
HOW MANY AUTHORIZATION PER CALL CAN WE HANDLE?
6