Where can you find the cause code?

When a clinical review determines whether the service is medically necessary, & verifies service is covered, & meets medical policy guidelines

Radiology, Anesthesiology, Pathology, Laboratory

Your doctor orders a mammogram to learn more about a lump she found at your last appointment.

A claim that matches key information that has already been received

When a provider or member must notify insurance before the healthcare service occurs

Per iBAAG, only these kind of rooms are covered

The acronym RAPLE stands for?

Performed when a member has a routine screening

Describes the type of service such as routine or illness

What tab can you find the remark code?

OBGYN bill services after birth

Like RAPL, allows INN processing of OON office based lab/x-ray under certain circumstances.

Medical coverage that means their plan has selected coverage for additional services under the preventive care benefit beyond what is required by the federal health reform law

Reprocessing turn-around time for a claim

Where can you find the diagnosis code(s)?

This service requires a notification prior to stay

OON office lab/x-ray claims processed at the INN level per iBAAG

If the procedure code isn't in ISET, where else can you find it?

This should only be used when a claim is not on file

Where can you find the check/epayment #?

These claims are processed outside of global reimbursement

OON office lab/ x-ray claims processed OON no matter what

Member calls in, says his bill should have been billed preventive, advocate calls provider, discovers the wrong diagnosis code was used, provider offers to send a what?

Fully insured is what code in the eligibility tab?