What are the classes that dental services are divided into?

What are the names of the two specialty pharmacy vendors that Premera utilizes for our members?

What is the name of the online resource that providers can utilize to see if a service requires a prior authorization?

When speaking to a Washington state provider, what is the first thing that we must obtain from BQT to verify their contracting status?

If a provider is calling because a member is coming to their office to be seen for daily headaches and nausea and they are requesting benefits for the visit, what benefit category would you quote?

What must always be offered when a provider is calling for dental benefits?

Medications that have the lowest cost share are referred to as ?

What is the name of the vendor that reviews the following services: CT scan, MRI, echocardiography, PET scan, sleep study, CPAP, genetic testing?

Which vendor does Premera utilize to give our members access to dental providers outside of Premera service areas?

Suzie is calling from Sound Mind Counselling Services and she has a patient coming in for an office visit with one of their Behavioral Health Therapists, what benefit category would you quote?

When reviewing codes on a Paccar account for a dental provider, what resource would we use to check the codes for authorization requirements and where would that resource be found?

These medications are used to treat complex conditions and are typically self-injected medications.

This is where prior authorizations and referrals are housed in Facets.

What tool is used to find if a provider is INN or OON?

Dr. Hamilton’s office is calling for coverage information for a sport physical and immunizations. What benefit categories would you quote?

Where would we review for dental claim history by tooth for a member?

Where are pharmacy claims housed?

What program is used to generate and store letters that are sent out to members and providers?

What would you have to obtain from BQT to help determine the contracting status of an out of area (OOA) provider?

When quoting Injection benefits for a provider, what additional benefit category would we quote if the provider is billing a separate administration fee?

These services are covered under the medical plan for dental treatment due to an accident (i.e. a child’s tooth being knocked out during a baseball game or being punched in the face and having a tooth fall out).

This online search is available to providers and helps to identify the benefit tier for a specific medication, or if the drug is covered under the medical plan. However, this tool does not provide cost or coverage details.

When checking CPT codes for prior authorization requirements in BQT, if a code comes up saying OPR, where would the provider need to obtain prior authorization from?

When speaking to a provider in California about a Microsoft member’s account, what question must be asked to determine the provider’s contracting status?

Dr. Jones is calling because they will be performing a biopsy in the office for a member and they will be sending the biopsy to a lab for analysis. What benefit categories would you quote?