PSJH Final - 2023 EDIT

What is PHP claims fax #?

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

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

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

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

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

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

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

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

When did PHP receive claim (#3)?

How long is written consent valid for in 2022?

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

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

What does a claim in status 02 mean?

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

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

What is Cigna's claims address & Payer ID?

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

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

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

What disclaimer is quoted when no authorization is required?

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

What does modifier RR mean?

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

Where do we direct ASO members for address changes?

CPT code 99213 does NOT require Prior Authorization.

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

A Vasectomy is covered for the group Covenant Health.

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

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

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

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

PHP does not accept retro prior authorizations.

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

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

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

How long is verbal consent valid for?

What does claim in status '81' indicate?

CPT code 31298 requires Prior Authorization.