Systems
The the main system we use for pulling up a member's policy.
Oneview
Therapeutic and elective
Abortion
Disclaimer for Accumulations.
As of today and subject to change, all accumulations are based on the claims paid at the time of the call.
or
Dollar amounts and visits accrued are subject to change and are based on claims paid at the time of the call.
The excel file for checking wellness procedure and diagnosis codes
Preventive Care Code List
Acupuncture code TYP?
ACU
It is used check whether the provider is contracted or not.
CPF or Session 4
Mirena
Intraurine Device (IUD)
benefit disclaimer for maternity services. Provider is OON and medicare is primary.
Based on medicare rates
The excel file for checking diagnosis driven codes
PXDX Listing
TYP: ULT, POS: Facility. Where do we quote?
Facility: BA > OP Lab & Radiology – Facility Services
It is used to check the code description and service type.
VIPR or Session 2
Where do you quote benefits for Screening Colonoscopy?
Early Cancer Detection > Colon/Rectal
Disclaimer for Additional Accumulators.
As of today & subject to change
MMM is PHS +, where do we check precertification?
Service Procedure Code Guide
What is the limitation of allergy testing procedure code 95165?
annual maximum of 150 units per rolling 12 consecutive months.
What action should we do to close VIPR properly?
ALT + X
or
Click VIPR-Action Tab
Then click Close
Where do we quote a general surgery service, done in office, looking for professional fee?
OPS > Surgery
disclaimer for INN preventive services
based on contracted rates
this excel file will determine if a provider is allowed to buy hearing aids from another vendor
Amplifon HCP Exemption List
The name of the PDF file for locating Specialty Medication?
Exclusive Specialty Home Delivery Pharmacy Medications Customer Drug List
In what specific area in CPF do we check if the provider is considered a PCP or specialist?
Provider Numbers (PROV#S)
Where do we quote benefits for a procedure code with TYP: PRD (External)
Medical Equipment & Supplies > External Prosthetic Appliances
Disclaimer for advanced radiological imaging services if the code requires precertification
Please be advised to not set an appointment with the member until precertification is approved
The excel file that we should check if maternity is only covered for Complications of Pregnancy
IFP / Group Maternity Complications
Probing question if the provider is calling for surgery done in an OP Facility.
Are you looking for facility or professional fee?