Worksheetsweek 4 review #2
Total questions: 10
Worksheet time: 20mins
What's the medical policy # where you can find the CPT codes that are consider experimental/investigational services.
12.01.01.rq
12.12.12.bq
12.34.56.bq
12.01.01bu
For nutritional counseling what are the two codes not eligible for reimbursment. Check Med policy and/or JobAid
(a)
Provider on the line is calling to know if IUD "PARAGARD" as non contraceptive use is eligible under the medical plan. Check, med policy and/or JobAid
There is not medical policy for this
Yes, it's eligible
No, it's not eligible
It does not specify in the JobAid
for IBX member, how many visits can the member get as preventive nutritional counseling?
Check JobAid and/or Med policy.
(a)
Provider is asking you if home infusion therapy needs precertification. What would you advise?
Yes, all home services need precertification through our Internal precert team
With no CPT code it's impossible to review it
No, no precert required
We cannot answer that question since we do not handle precertifications
Using member ID 8004021700, what's the benefit to select for cpt 76700?
Advanced radiology
Physical therapy
Contraceptives
Is precertification required for G0562 ? if so, who handles it?
Yes, precert is required through Carelon
That codes does not exist
Yes, precert is required through our internal precertifications department
No, no precert required
Using CFI, for member ID 5100218400, what is the OON OOP max amount and its accumulations?
INN $6750 and accumulated as of today $450.65
OON $5000 and accumulated as of today $801.90
OON $12,000 and accumulated as of today $1320.05
Using CFI, for mbr ID 8134529100, what was the Deductible for INN tier 1 individual and accumulations?
$9800 and $0 accumulated as of today
$2000 and $0 accumulated as of today
$4000 and $0 accumulated as of today
using CFI, for mbr ID 8135817800, what is the designated site for Radiology services?
LabCorp of America Raritan
Holy Redeemer Hosp and Medical Ctr
Abington Memorial Hospital
