Week 6 Jeopardy

Week 1-6

100

This is the phone number to call Certified Languages (interpreter services)

877-241-2346

200

To obtain Housing-related support for applicable members, it could take ___ to ____ days before services are delivered

30 to 60

300

What is the timely filing limitation for claims submissions for PERS Medicare Supplement members? 

12 months from the date of Medicare determination to the Moda received date

400

What line on the prioritized list does DX code M25.111 fall on?  Is that funded or non-funded?

521 and non-funded

500

Search the Practitioner Application and pull the practitioner's P1422763 number - This is the provider's current in network effective date

09/22/2022

Medicare Supplement-Claims

100

Pull up Claim #233533611600 in Claims Inquiry-Web.  Medicare paid ______ on this claim

$549.40

200

Pull up Claim #233555053200 in Claims Inquiry-Web.  True or False:  This is a facility claim

False

300

Pull up claim #240193288700 in Claims Inquiry-Web.  The reason this claim didn't pay

Went to towards Medicare Part B deductible.  ($160.69)

400

Pull up Claim #240793046300 in Claims Inquiry-Web.  The reason this claim didn't pay is ______

Medicare paid their full allowable of $23.76

500

Pull up Claim #240683182500 in Claims Inquiry-Web.  This amount went towards the member's Medicare Part B deductible.

$73.76

EOCCO-Claims

100

Pull up claim #241104387500 in Claims Inquiry-Web.  The reason for this claim denial was

Pre-Auth violation

200

Pull up Claim #232343329600 in Claims Inquiry-Web.  This is the member's patient account number

I16298517S4314912

300

Pull up Claim #243372209100 in Claims Inquiry-Web.  This is the reason the claim denied

48R - No Response from Provider - Med Records

400

Pull up Claim #242923394200.  This is the 3rd diagnosis code billed.  (Need both Code and Description)

I63.511 

Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery

500

Pull up Claim #241373514300.  This is the reason the claim denied

Clinical Edit:  [Trauma response code G0390 not submitted in conjunction with revenue code 068X and CPT code 99291 on the same date of service]    

Medicare Supplement-General

100

The 2025 Medicare Part B Deductible

$257

200

This is the annual high-deductible amount for a OR Supplement member on a Plan G

$2870.00

300

The group number for Texas Medicare Supplement Plans that we offer

10026903

400

For Community Medicare Supplement plans, this calendar year deductible amount must be met prior to Moda paying 80% for medically necessary emergecy care.

$250

500

This is where you would route if an OR/AK Community Supplement member wants to terminate their plan.  

R046 (MA CS Medicare).  Additionally, you can also email [e-mail]

Misc.

100

The name of Aspen's cat

Nacho

200

Pull up Sub ID: T72133158

This is the per day rate of coverage for 2025 Skilled Nursing

$209.50 per day.

300

Pull up Sub ID T72133158 in Benefit Tracker.  This is the copay amount for a WellVision Exam.

$15

400

Member Document or Plan Document:  A PA Decision letter is considered a 

Member Document

500

**Pull up your InContact Skillset Names and Definitions spreadsheet**

Provider calling for Sub ID P20261662

The appropriate skillset from CXone you will transfer this provider to assist with their question is 

MED_360_PEBB_P