DME
The vendor responsible for DME distribution for our members in Oregon and SW Washington.
*Bonus: What is their phone number?
Providence Home Services
*BONUS: (503) 215-4663
The two types of influenza (flu) vaccines that are covered.
What are the flu shot and FluMist?
The vendor used for our alternative care network.
What is ASHN? (American Specialty Health Network)
The healthcare reform influenced the way that contraceptive services were covered in this way.
What is "covered-in-full"?
The claims address.
What is PO Box 3125 PDX, OR 97208?
The location code/place of service code which indicates "Patients Home".
What is POS 12?
The 5 immunizations that are covered for school, work, and travel purposes without a PA.
What are: HEP A, HEP B, Varicella, Measles, Mumps and Ruebella (MMR) and Meningococcal
The benefits needed to quote for a member calling for acupuncture benefits.
What are: Acupuncturebenefits, OV to an alternative care provider, xrays/labs and outpatient rehab.
The benefit for an office visit related to contraceptive methods and counseling.
What is covered-in-full?
The 2 things we need to tell members when ordering an ID card for them.
1. It will arrive in 7-10 business days
2. It arrives in a plain white envelope
The dollar limit for foot orthotics for MBR ID 100698357-00.
What is $200 per calendar year? (deductible waived)
The type of HCPC code billed for medications relating to injections.
Hint: It's a letter..........
What are "J-codes"?
The plan that has coverage for massage therapy.
What is Intel?
The diagnosis that needs to be billed for an IUD in order for it to be covered-in-full.
What is "contraceptive"?
The CPT code that is for venipuncture/actual drawing of blood.
What is 36415?
The benefit that lancets and test strips fall to for members with diabetes.
*HINT: Diabetic supplies or DME?
What is the diabetic supplies benefit?
The benefits needed to quote for an in-office injection.
What are "Injectable Medications" and "Surgery/anesth (in office)"?
The CPT codes that can be billed for 1 unit and fall to the OP rehab benefit.
What are 97124 and 97140?
The benefit for the removal without reinsertion for the Nexplanon.
What is the surgery and anesthesia benefit?
The answer to whether or not a prior authorization is required for CPT code 95974, nerve stimulation.
What is "Yes"?
Bonus: How does a provider submit the request?
The POS that needs to be billed for HCPC code A7034 to be covered.
*BONUS: Is a PA required?
What is POS 12?
*BONUS: No PA is required
The benefit quote for MBR ID 100674302-00 receiving an in-office injection for J1720.
What is:
$350 DED, 15% COINS, up to $1500 OOPM.
J1720 - Payable, no PA required *QPAD*
Quote the in-network chiropractic benefit for MBR ID 100698357-00.
OV - $250 DED, $10 CP - does not apply to OOPM
Chiro - $250 DED, $10 CP - does not apply to OOPM
Xray/Labs - CIF, ded waived
OP Rehab - $250 DED, $10 CP, up to the $1500 OOPM, with a visit limit of 60 visits PCY comb w/ PT/OT/ST
The HCPC code billed for a Mirena IUD.
*BONUS: Does it require a PA?
What is J7298?
*BONUS: No
The number outpatient rehab visits that MBR ID100675920-00 has remaining to use this year.
What is 56?