Premiums
Types of payment options
What is IVR, Online or Mail?
5W's
What is Who, What, Where, When & Why
Job aid for Claims
What is Claims Resource Index - IFP (
KM1251273)
Job Aid for Pharmacy
What is Rx Benefits (KM1244327)
Length of Grace Period for members
What is 3 months for members with subsidy / 1 month for members without?
System used for Expedited Appeals
What is Macess?
length of time for online changes to show in Facets or Maestro
What is 24-72 hours?
Name of the tab in Facets to member responsibility
What is Line-Item Details?
we use to update eligibility
What is Pharmacy Escalations SP?
Binder Payment Due Date
What is the 1st of the plans start month?
states that allow 2nd level Appeals
What is TN & NC?
The system you can see a paper application
What is View?
Job Aid for BB
What is Cease Billing SOP (KM1230027)
system to see Rx authorizations
what is PAS or RXClaims?
Name of system to see payments
What is UPG (United Payment Gateway)
States that allow standard appeals to be verbal.
What is MD and WA?
If plan error where is route sent
What is B&E?
Name of Chat for Claims Assistance
What is Helping Hands Chat?
System to locate coverage of medication
What is Maestro?
When do claims get pended for 2 months
What is during Grace period (all states except TX)
System that appeals can be seen in
What is ATS?
Dept to transfer if no broker information is available
What is Telesale?
Length of time to respond back to Claims
What is 10 minutes?
screen in RXClaims to see claims details
What is Claims transaction Detail?