BAR benefits

What system do you use to check the member's benefits for a specific service?

• AVA/B360

• ISET

• IBAAG

• ICUE

What system do you use to check the member's benefit accumulators?

• AVA

• B360

• ISET

• ICUE

What resource can you use to find CPT or diagnostic codes?

• KL

• KC

• OCM

• ISET

What is a copay?

• A flat dollar amount

• A percentage to be paid after deductible has been met

• The overall amount of money spent on services

What is a deductible?

• A flat dollar amount

• A percentage to be paid by the member

• The amount of money due by member before insurance starts to pay something

• The overall amount the member pays for services in a year

What are the Big 7?

Do you need to talk about benefit exclusions?

• Yes, always

• NOPE

• Yes, only if listed

• Only if the member asks "what is excluded in my plan"?

Is an authorization required for routine outpatient services?

• Yes

• No

• Maybe? I will just refer to the provider

What is the difference between INN and OON?

What are some examples of limitations/exclusions?

• Limited number of sessions

• Age restrictions

• Sex limitations

• All of them