Systems
Precertification Lookup Tool - used to determine if PA is required
What is PLUTO?
EOB
What is Explanation of Benefits?
Type of claim submitted for an inpatient stay
UB-04
Locate Rx Prior Authorizations
What is PA Hub?
Anthems Dental vendor
What is Liberty Dental?
Locate prior authorizations status
What is MAS Toolbar?
LIS
What is Low Income Subsidy?
Queue to request adjustment to claims
Government program for Medicare beneficiaries who have limited income
Low-Income Subsidy
Used to emulate a members online profile
CAD Admin Tool
View status, reissue, or void a check
What is Check Inquiry Tool?
EOC
Code describing patients condition (ICD-10)
What is a Diagnosis code?
Used to locate drug accumulators
What is Account Summary?
Anthem's Hearing Vendor
What is HearUSA?
Used to order Provider Directories
What is CustomPoint?
LEP
What is Late Enrollment Penalty?
Codes billed on Outpatient and Inpatient Facility claims
What are Rev Codes (Revenue codes)?
Override for members leaving the country for less than 6 months
Used to review provider disputes and appeals
PEGA
Used to store EOBs, invoices, provider remits, etc.
What is OnDemand/Webi?
POS (no, not that one)
Sends Submission Format (SF) for ITS claims
What is Host Plan?
Required for a Lost/Stolen medication override
What is a police report?
Anthems initial decision regarding the provision of medical care/services
What is Organizational Determination?