What information is required to properly validate a provider or facility?
Provider TIN, Caller Name Customer Name & DOB
15
What does claim disposition code X mean?
Claim denied
15
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?
15
Where would you look in BA to see if a customer has coverage for the Hepatitis B vaccine?
medical, outpatient physician services, preventive care
15
What is the BIN & PCN will we use to bill for medical vaccines?
00403 CIGPPOIMM
15
Does 72146 require authorization?
Yes
15
What benefit would you quote for 72146 performed at ABC radiology center?