PSJH Final

Where do we direct ASO members for address changes?

CPT code 31298 requires Prior Authorization.

When documenting a claim, what should always be in your summary?

You can provide denial info for a claim in status '11'.

Where does a Cigna provider submit a PA for high tech imaging?

PHP does not accept retro prior authorizations.

What benefits should we offer if a member goes to a chiropractor?

Claim (#1) Is this provider in or out of network? Can the provider bill the member for disallow amount?

If a Premera provider is calling for payment details on a claim, we transfer the call to Premera.

CPT code B4216 requires Prior Authorization

What is the name of the network/ vendor used for alternative care for PHS Oregon?

When did PHP receive claim (#3)?

What network is used for a SJH N. CA HSA plan for services rendered in WA?

Besides the COB task page, where else can we find details of COB information?

What disclaimer is quoted when no authorization is required?

What do we say to members when we order a new ID card for them?

For PHS Oregon and St Joseph N. California, Optum is our Behavioral Health vendor.

HCPC code E0483 is covered in-office.

What is the network used for PHS Oregon EPO in Alaska?

HCPC code A6412 is covered if obtained from a DME Supplier.

What is Cigna's claims address & Payer ID?

What network is used for a PHS Washington HSA plan in Montana?

What is the application within facets that CS can use to view specific details on auths, including HCS notes?

What does ASO stand for?

For claim (# 5), the payment was made through a bulk paper check.

What is PHP claims fax #?

What does modifier RR mean?

What is timely filing for an initial claim submission from most providers, and members?

For PHS Oregon EPO and SJH Oregon EPO, what do we need to verify every time we are in their account

What is the name of our provider portal?

What does claim in status '81' indicate?

How long is verbal consent valid for?

What is the main function of our Health Care Services (HCS) Department?

What available action do providers have for clinical edit u13?

CPT code 99213 does NOT require Prior Authorization.

The two types of breast pumps PHP covers are a commercial grade purchase and a hospital grade rental

CPT code L3765 requires a Prior Authorization.

What tool does customer service use to look up providers/ facilities in Oregon and SW Washington?

Who is the preferred vendor for DME in Oregon/ SW Washington?

How long is written consent valid for in 2022?

How long does a member have to appeal a denied PA?

Members spouse is calling for claim status on member (#2). Is there consent on file and if so, how long is it valid for?

A Vasectomy is covered for the group Covenant Health.

What is the total member responsibility for claim (# 6)?

What does a claim in status 02 mean?

For claim (# 4), what is the total allowed?

What available action do providers have for clinical edit z45?

What Facets application do we transfer to when checking weather there is consent on file?

What available action do providers have for clinical edit z60?