Puppies
. A _____ is a group of providers that will provide their services at a lower than usual contracted rate.
Network
Which of the following can be a Primary Care Physician (PCP) on most of our plans?
MORE THEN 1 Answer
Internal Medicine
Pediatrician
General Practice
Family Medicine
Who can be part of a network?
More then 1
A. Physicians
B. Hospitals
C. Chiropractors
D. Physical Therapists
E. Medical Equipment Suppliers
FUNNYYYYY
How many dogs does lacey have?
2 fur babies
How many toddlers does Sarina have
2 sweet babies
Where would you find an address of the patient?
Bat cave/ drop curtian
When a provider is part of a network, they must accept a discounted rate of payment.
True or False?
True
General Practice, Family Practice, Pediatrician, and Internal Medicine are all types of _____________
PCP
A member always has the option to travel for care and use their wrap network.
Treu or False?
False
A network available to the member when they are traveling or temporarily out of the primary network area
Wrap network
Explain a COB
In the bat cave you will see if there is a COB update if they have another insurance
A type of provider that, after completing medical school, will further their medical education in a specific field or body part
Specialist
Normally used by hospital systems, and the member usually will get the best benefit in the primary network is what
Tiered networks
The network that will provide the member with the best benefit level is their _____.
Primary network
A smaller network that will typically only encompasses a small geographic area like a group of several counties is a what?
Localized network
An instance where the plan may pay a better benefit for a member who saw an out-of-network provider in an emergency situation
Out-of-network-pay-as-in (OON-PAI)
Where do you go in PIVIT to determine if a provider is in-network
The network website link
A secondary network that members have access to when they are temporarily outside of their primary network area is called a _____.
Travel/Wrap network
The section of Smart Benefit Search you would reference when quoting benefits for a sick office visit with an OB/GYN
PCP Office Visit
If a plan has OON/PAI (out of network/pay as in) benefits, when can this benefit be applied?
When services needed are not offered by an INN physician
If the provider address isnt in search are they INN?
No they are OON
Where would you find SBS?
Employeer link in pivit
When calling the network to verify if a provider is participating, you need three things: the provider’s billing name, billing address, and ______________________
Tax ID #
United Healthcare, Aetna, and Anthem Blue Cross Blue Shield are examples of a possible _______________that our larger nationwide clients may choose to contract with
National Network
DOUBLEEEEEE points!!!!!
Who can tell me if the DOB is wrong, name or any spelling of a patient, who do they have to get this changed with?
HR Dept with employeer.