Has Jeopardy Jeopardy Template

BLUE SQUARED	ABBREVIATIONS	INELIGIBLE REASON CODES	PROVISIONS	DEFINITIONS
100 400 What is the TX plan code	100 Blue on Blue (coordination of benefits) BOB	100 Medical record required 360	100 Office Visit OVIS	100 Appeal A request for your health insurance company to review a decision that denied a benefit or payment
200 SCCF The first three numbers of this number sequence indicates what state the host plan is located in	200 Document Control Number DCN	200 No pre-authorization was obtained and records are required to make a determination 22E	200 Physical/Mechano Therapy - Outpatient or Inpatient PTMO / PTMI	200 Pre-determination Written request by a provider to determine if a proposed treatment or service is considered medically necessary and/or covered under a patient’s health benefit plan.
300 Host Plan The plan that contracts with the providers who provide medical care to Home Plan Members	300 Ring on No Answer RONA	300 This charge is a duplicate of a previously processed claim 129	300 Surgery - Outpatient or Inpatient SRGO / SRGI	300 Peer to Peer Review When a provider calls and schedules a conversation with a Medical Director. This gives the provider an opportunity to add or clarify clinical information as necessary.
400 SF (Submission Format) Created and sent by the Host Plan to the Home Plan Provider (Host) claim being sent to the member's (Home) Plan	400 High Deductible Health Plan HDHP	400 On or after termination date 011	400 Muscle Manipulation - Outpatient or Inpatient MMO / MMI	400 Pre-authorization The process by which members or their doctor notifies the health plan, before the member undergoes a course of care, such as a hospital admission or a complex diagnostic test.
500 General Inquiry (GENINQ) This message type is used to request information, obtain clarification, or follow up on a request	500 Explanation of Medicare Benefits EOMB	500 eviCore denied the procedure code as not medically necessary 23E or 26E	500 Diagnostic Medical Procedure - Outpatient or Inpatien DMPO / DMPI	500 PAR Provider When the provider can accept our contracted rates and will NOT balance bill the member however, the accums still go towards OON accums

HAS JEOPARDY

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