PCP Changes
Which role you will route to for PCP Changes?
R036- MA Medicaid Specialist
True or False: If COB is involved, Medicaid always pays first
False
True or False: EFTs generated by Moda will appear as Current Status "EFT Created"
True
When you are filing a grievance for a membr, what subject and category you should use?
Grievance/Appeals, Grievance/Appeals
____ to a Person and _____ to a Reason
Pend & Route
How many days do members need to select a PCP?
30 Days
What section in Facets will you look for more detailed information for COB?
Related Notes / Subscriber Notes
Who sent the payment out when the Disbursement Method says External Check Payment?
Zelis
Claim # 243413620600
What is the billed amount and date of service for this claim?
DOS: 12/02/2024, billed $266.00
Input Member ID F15131632 into Benefit Tracker.
What is the phone number for this members plan?
1-888-217-2363
What 3 things are needed in your task note when you route a PCP change off?
Claim #243454663100.
What is the allowed amount from EOCCO?
$108.17
Which P&P covers all things about Accounting and Payments?
MED2710 - Researching Payments and Recoveries
Claim #243582923500
What is the clinical edit denial?
u49 - Age Conflicts with Diagnosis
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
Which P&P goes over how to select PCP?
MCD8
Claim #243524954000.
What amount did the primary insurer pay?
$127.17
In the Payment Application within the Accounting Application - pull up Payment Reference ID:
2021123110500489. How many claims are involved a recoup/recovery?
2
Please pull up Sub ID YC800M0J in Benefit Tracker
No Prior Authorization is required for all combined therapy visits until the ___ visit?
The 61st
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
Pull up Sub ID: YM701F3W
Who is listed as their current PCP?
Yakima Valley Farm Workers Clinic Hermiston
Claim #243113822100
What is the name of the member's primary insurer?
Medicare
Search the Payment Application for Check #1301343.
What is amount of this check that was paid out?
$297.60
These are the five covered HRSN (Health-Related Social Needs) Climate Devices that can be offered
Air Conditioners
Air Filtration Devices
Mini Refrigeration Units
Portable Power Supply
Portable/Space Heater
Please pull up the Practitioner search in Facets and search - P00001418767
The EIN/Tax ID listed for this provider
930425580