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Specialist/Diagnostics
Provider Directory
Preventive Services
Networks
100

Whether or not we can change the address for MBR ID 113213008-00.

BONUS: Why or why not?

What is no?

BONUS: EDI Group - changes go through employer.

100

The two plans that require referrals for specialist services.

What are Choice and Connect?

100

The name of the only hospital located within 5 miles of zip code 97068 for MBR ID 112960565-00.

What is Providence Willamette Falls Medical Center?

100

A group that is allowed to have a cost-share for preventives services and an option to provide benefits that favor highly paid employees.

Extra hint: It states GR at the bottom of the benefit summary.

What is a grandfathered plan?

100
The network used for choice members.
What is the Providence Choice Network?
200

The name of the primary insurance listed on file for MBR ID 100118445-01.

What is United Healthcare?

200

The benefit quote for an in-network specialist OV for MBR ID 100186712-00.

What is: $10 CP, deductible waived, which applies to the $1200 OOPM?

200

The number of results when searching for a medical home/neighborhood for MBR ID 113047871-00 within 5 miles of zip code 97045.

What is 8?

200
The numbered limit of how many annual GYN's a member can get in a calendar/plan year.
What is 1?
200
The network used for Connect members.
What is the neighborhood network?
300

What status 11 means.

BONUS: Can we give information out on a claim in this status?

What is pending?

BONUS: No.

300

The modifier billed which tells us where a member physically presented for diagnostic radiology (ie: xray)

What is modifier TC - Technical Component?

300

The names of the two male, Spanish speaking orthopedic surgeons listed within 5 miles of zip code 97216 for MBR ID 100185415-00

Who are Douglas Bald and Gavin Button?

300
This happens if a member sees a non-participating provider for a routine physical.
It falls to the member's OON benefits and the member has a higher cost share.
300
The network used in Oregon and SW Washington for all non Choice and Connect members.
What is the EPO/Signature network?
400

The process in which MBR ID 100961682-00 has to follow to get their address updated.

What is: Send notification in writing to Membership Accounting (MA) whether via mail or email?

400

The CPT code billed for a venipuncture (blood draw).

What is 36415?

400

The network that Dr. Ann Bridges, OBGYN, is a part of at 904 7th Ave for MBR ID 112865011-00.

What is the FCHN network?

400
The place in which a choice or connect member must be seen to receive in-network benefits for their periodic health exam.
What is the member's medical home/neighborhood?
400
The network used for a member with in-network benefits in Seattle, WA.
What is the FCHN network?
500

Whether or not we can give a parent of an intact family information about a dependent under 18 regarding IUD's (family planning).

What is no?

500

The benefit quote for an in-network specialist office visit PLUS xray/lab benefit for MBR ID 113082936-00.

What is:

Specialist OV: CIF after family deductible of $13,100

Diagnostics: CIF after family deductible of $13,100

500

The name of the only UC facility located within 5 miles of zip code 97006 for a prospective individual choice member.

What is Providence Medical Group - Tanasbourne Immediate Care?

500

The labs that are considered preventive for adults and therefore CIF for member's on a non-grandfathered plan who have adopted PPACA.

What are: Cholesterol Screening, Diabetes Screening, Hep C Virus Screening (for adults born between 1945-1965), HIV Screening and Counseling, and Syphilis Screening.
500
The network used for a member with in-network benefits traveling to Boise, Idaho? (Southern Idaho)

What is Brightpath OR PHCS/Multiplan Network?

***Network layering***