Member Eligibility
Where do we get the original effective date for the spouse/dependent in Ncompass?
Get More - Contract details
KHub page - Verifying Contract and Member Eligibility - NCompass
How should we handle coverage inquiries for upcoming procedures when the member cannot provide a procedure code?
Offer general benefits
• If unable to determine benefit to quote, either call HelpDesk or contact provider to obtain further information (In-state providers)
What are the required verification details before proceeding with contract details or accessing a member’s account?
Full Name, Date of Birth, zip code, and one element of non public information (Subscriber ID/SSN)
What are the five DRP process?
Clarify and Confirm
Probing
Direct Answer
Pause
Additional Guidance
Where do we get the original effective date for the subscriber in Ncompass?
View Benefits service task - Contract information
KHub page - Verifying Contract and Member Eligibility - NCompass
What cost share information should we provide if the provider status was not determined on the call?
Provide complete in-network (INN) and out-of-network (OON) cost share details, including balance billing information.
If a caller is calling on behalf of another member, what additional verification questions are required?
What letter is used to drop PIP (Personal Injury Protection) coverage with your auto insurance?
Qualified Health Coverage Letter
Where should we verify if the member’s dental/vision policy is pediatric or not?
Contractual Documents
What provider status applies when a provider has no agreement, not required to file claims for members, may charge above the allowed amount, and payments are sent to the subscriber?
Non-participating providers
Can we disclose PHI to a third party without verbal authorization?
No. PHI cannot be disclosed to a third party without obtaining verbal authorization first.
What is the name of the Knowledge Hub article that CSRs should follow when a member requests to speak with a US representative?
Caller Questions CSR Locations