Week 4 and Beyond Jeopardy

PCP Changes

100

This is the role you will route to for PCP Changes

What is:  R036- MA Medicaid Specialist

200

How many days do members need to select a PCP?

What is 30 Days

300

These are 4 things needed in your task note when you route a PCP change off

What are:

• Name and PID of the new PCP
• Effective date of the change 
• Who is making the request –     member or provider?

400

This P&P goes over how to select PCP

What is: MCD8?

500

Pull up Sub ID: 

YM701F3W - This person is listed as their current PCP

What is Yakima Valley Farm Workers Clinic Hermiston?

COB

100

True or False: If COB is involved, Medicaid always pays first

What is False?

200

What section in Facets will you look for more detailed information for COB?

What is Related Notes / Subscriber Notes?

300

Please pull up Claims Inquiry-WEB and look up Claim #

243454663100.  The allowed amount from EOCCO is

What is 

$108.17

400

Please pull up Claims Inquiry-WEB and look up Claim #

243524954000.  The amount paid from the Primary Insurer is

What is 

$127.17

500

Please pull up Claims Inquiry-WEB and look up Claim #

243113822100 - What is the name of the member's primary insurer?

Medicare

Accounting Application

100

True or False:  EFTs generated by Moda will appear as Current Status "EFT Created"

What is True

200

Who sent the payment out when the Dispersement Method says External Check Payment?

What is Zelis

300

The P&P that covers all things about Accounting and Payments

MED2710 - Researching Payments and Recoveries

400

In the Payment Application within the Accounting Application - pull up Payment Reference ID:  

2021123110500489.  How many claims are involved a recoup/recovery?

2

500

Search the Payment Application for Check #1301343.  What is amount of this check that was paid out? 

What is $297.60

Weeks 1-4

100

When you are filing a grievance for a member, this is the subject and category you should use

What is:  Grievance/Appeals, Grievance/Appeals

200

Please pull up Claims Inquiry-WEB and input

243413620600 - The billed amount and date of service for this claim is

DOS: 12/02/2024, billed $266.00 

300

Please pull up Claims Inquiry-WEB and input

243582923500

The Clinical Edit denial for this is

u49 - Age Conflicts with Diagnosis

400

Please pull up Sub ID YC800M0J in Benefit Tracker - No Prior Authorization is required for all combined therapy visits until the ___ visit?

What is the 61st

500

These are the five covered HRSN (Health-Related Social Needs) Climate Devices that can be offered 

What are:  

• Air Conditioners
• Air Filtration Devices
• Mini Refrigeration Units
• Portable Power Supply 
• Portable/Space Heater

Misc.

100

There are _ pairs of suite tickets to see Forrest Frank on 04/29

8

200

____ to a Person and _____ to a Reason

Pend & Route

300

Pull up the Focus Chart and look up CPT 40819;  This is the Guideline Note that goes over Frenotomy for tongue tie in newborns 

Guideline Note 139

400

Please pull up the Practitioner search in Facets and search - P00000768662.  What is the Provider Group that this Practitioner is a part of?

University Professional Services

500

Please pull up the Practitioner search in Facets and search - P00001418767

The EIN/Tax ID listed for this provider 

What is:  930425580