What information is required to properly validate a provider or facility?
Provider TIN, Caller Name Customer Name & DOB
What does claim disposition code X mean?
Claim denied
What would you type into Inquiry for this caller request? “I’m calling from Kroger Pharmacy to verify if the customer has coverage for Hepatitis B because they are traveling over seas.”
Does our customer have coverage for the Hepatitis B vaccine?
Where would you look in BA to see if a customer has coverage for the Hepatitis B vaccine?
medical, outpatient physician services, preventive care
What is the BIN & PCN will we use to bill for medical vaccines?
00403 CIGPPOIMM
Does 72146 require authorization?
Yes
What benefit would you quote for 72146 performed at ABC radiology center?
Medical, advanced radiology imaging, outpatient facility
Will a precertification for 72146 go through eviCore or Cigna?
eviCore
Where can you look to see the balance of a choice fund account?
OneView balances portlet click expand
Where would you look to see if a medical necessity review for PT is approved and how many visits are authorized?
Ashlink
Where can you find a customer's original effective date?
OneView - Customer information - Active/Future coverage
Where can you see COB information for a customer?
OneView - Eligibility - COB Portlet
Where is the disposition code?
OneView - Claims Tab - middle
What information do you need to send a claim for a pend release?
Check to see if: the account is on hold, if it's been more than 21 days, If the claim is pended for pricing
Where can we see if a claim is enhanced?
ViPr Auth field
True/False A provider can submit an appeal by calling Cigna.
False
