Admin Portal
Locate this member and tell me who the current broker is.
Heather Francis
What is the balance for this member?
What is their Paid through date?
323.40 || 08/31/2026
What department processes terminations?
Billing Department
What are 4 things that we use five9 for?
Inbound calls
Outbound calls
Emails
Voicemails
If a members MRI benefit is $30.00 but they haven't met their deductible yet, does the deductible apply?
No deductible does not apply.
When did we receive the PHI form for this member?
05/29/2027
What is this members balance and what month is it for?
299.15 for September
What department provides oversight of our Pharmacy benefits manager?
Pharmacy
What Not Ready reason code would you use if you step away from your desk?
Personal- unavailable
What is the difference between a Grievance and a appeal?
A grievance is a complaint filed to the insurer to communicate dissatisfaction with customer service and a appeal is a formal request by a member or provider regarding a decision on a claim denial/auth.
$12644.84
Is this payment amount for the following member in the suspense account?
Amount $ 155.53 paid on 08/24/2026
Yes it is in the suspense account
What is business development?
Builds and manages relationships withe brokers.
What is the difference between warm and cold transfer?
With a warm transfer you would remain on the line with the member and with a Cold transfer they would be transferred without the CSR
What is a 4th QT rollover and when does it occur?
Any amount a member pays toward their Deductible between 10/1-12/31 will apply to the next year plan except to a HDHP
For the following Tax ID and NPI are they in network? Address: 725 Glenwood Dr ste E790, Chattanooga Tn
Who is their PR rep?
When did they become in network?
The provider is in network
Shawna Voyles> Brittany Litke
04/30/2025
Locate this member on ACH and answer the following questions
1. When did they set up ACH?
2. What are the last 4 of the account #?
12/19/2025
3362
What department is the middle man between the insurance and providers?
Provider relations
How often do you check with a member after putting them on hold?
every 3-4 minutes
What is the difference between EOP and EOB?
EOP is sent to the provider after a claim has processed and a EOB is sent to a member after we process their claims.
This member is needing EOBs from dos 03/01/2026 to 07/01/2026, how many claims do we have?
5
When was the last time this ach account was updated
08/12/2026
What department helps employers implement and manage their ICHRA?
What other system is synced with five9?
Who is a EPO plan offered to?
What do these plans start with?
Do they have out of network benefits?
TN members
1
No out of network benefits