BENEFITS
This benefit has no out of network benefit
Emergency Services
These benefits is used to indicate that a service is done by a professional
Professional services, surgery - surgeon
With this tool I can find contract status
CPF
How can you tell the difference between a subscriber and a dependent
with the person suffix code/ person code
This is the disclaimer that we normally say for the accumulators
the dollar amounts and visits accrued are subject to change and are based on claims paid at the time of the call
For these 3 benefits I should ask if services are related to behavioral health
PT, OT, SPT
In this tool, what are the steps needed to see the member’s address
CED, enter member id, x beside the name press enter, place the x beside member name press f2 twice
on the eligibility tab where would we know if the account is either an alliance or payer/third party
elig & claim system, line of coverage and alerts
To read the correct benefits for surgery where would you read
surgery is read from the place of service and if it is professional
For this benefit, it must be elective or therapeutic
Abortion
In cpf where do we find that the provider is either a specialist or PCP and where would we go to see if they are contracted
SUMMARY PAGE AND THE NETWORK RELATIONSHIPS PAGE
in CED what is the function on the member account that we press to see other insurance and also in oneview we see this as well, where?
F9, and the coordination of benefits tabs
The network id shows that the provider is not contracted with ash and that the zip code is 90210, what would be the network id for ash and is MNR required
NW360, NW353 and YES
For an MRI service you would need ___ and _____ to read the correct benefit and where would you read the benefits from?
Codes, place of service and Advance radiology
I normally use ____ to see the member’s eligibility, but I can also use _____ and ____
Oneview, CED,Vipr
MNR is required after the 5th visit, can this requirement be different and how
YES, BA states otherwise, SALT says not ASH, clients opts out
What is covered under infertility?
This is needed to pass HIPAA
provider TIN, provider/facility/office name, member name and DOB