Reimbursement Policy
What is the number of minutes that equals 1 unit of anesthesia?
15 minutes
The system that houses all claims for Oscar?
Cortex
What provider identifier would be used to search for the contract in Faxblast?
TIN
What is the most common pricing methodology for provider claims?
CMS
Which type of Cotiviti denial is always upheld?
PPM
What type of anesthesia provider must bill with modifier QX.
CRNA
The system where all provider contracts are stored?
Faxblast
In order for a provider to have a contract with Oscar they must be this?
In Network
What does an escalator do to pricing?
Increases it
How can you view the NDC number in Cortex?
Actions, View/Edit raw claim
E&M codes billed with REV 510-519 on a UB04 claim are not reimbursable. What type of facility does this apply to?
Hospital Based Clinics
The processors should do this their Appian ticket when taking break, lunch or end of day?
Pause
What part of the contract shows the fee schedule?
Compensation
What are the 2 most common pricing methodologies for Inpatient claims?
DRG and IPPS
What kind of reduction is applied to radiology services billed on a UB04 claim?
TC override/TC modifier reduction
What does the modifier AS represent when billed with a cpt code on the claim?
Assistant Surgeon
The feature in Cortex that provides clarification on certain non-reimbursable denials?
Insights
What type of document in Faxblast, might include an updated fee schedule?
Amendment
What is the difference between first and second dollar pricing?
First dollar pays a % of the full billed amount of carveout, second dollar pays a % of the amount above the threshold
In order to price an unlisted procedure code, the processor must first find this type of code?
Comparable
Nurse practitioner is this type of provider per the reimbursement policy?
Mid Level
The ticket that the processors work in Appian is called what?
The Child Ticket
Documents in Faxblast such as Settlements, NDA's and Joinders will never include this?
Fee Schedule
The pricing agreement with the provider where they are paid a set amount for each patient that is enrolled?
Capitation
What are 2 documentation categories that clinical guideline denials fall under?
Medical Records and UR Appeal