Advocate Jeopardy

R

100

This advocate collects all coins and all mints of a one dollar bill. 

Who is VIKKI MITCHELL

200

When quoting eligibility and benefits, how many inquiries should you have? 

What is 2 (TWO)

300

Clicking on the STAR next to the KB# in Knowledge Now

What is, how you save your favorite KB's to EN.

400

Turn Around Time (TAT) for an OON provider to submit a claim?

What is 365 days

500

Information needed when sending an issue for Hospice Date Validation 

What is 

• Member Name
• Member Plan ID
• Member DOB
• Hospice Dates in GPS
• Hospice Dates Given by Caller

O

100

Eligibility Update TAT

Routine : 30 days

Urgent : 24-48 hours

200

Information needed when sending an email to Supervisor to update IEX for a system outage.

What is -

Ticket Number:

 Details  Description of Issue:

 Affected  System(s):

 Troubleshooting  Steps Taken:

 What did IT  advise?:

 Start/End Time of  System Outage

 Leader(s)  Contacted

 

300

Category and Sub Category for sending a claim back for Reconsideration?

What is Claims and Reconsideration Request

400

W-9

What is the form the provider needs to fax in to get their address updated.

500

The template you use in MTW to send an ISSUE for a provider rep.

Issue Category

Provider/ Contracts

Issue Subcategory

Service Lead Research/Clarification

Assignment Group

Service Lead - OC

SA When to Use

SA needing lead or supervisor assistance with provider's contract, network status, wanting to join the network for AZ/NV, or provider rep needs to follow up.

Short Description

Provider/Contract Research

Join the Network

S

100

D M R

What is Direct Member Reimbursement

200

This advocate is a PACKERS fan 

Who is BRITTANI DAVIS

300

In CCSI the BLUE PLUS icon next to claim number OPENS

What is the CLAIM DETAIL

400

Definition of Empathy

What is the ability to understand and share the feelings of another. 

500

M I P S 

What is Merit-based Incentive Payment System.

• OptumCare DOES NOT participate in the program for our contracted/INN providers but we are required to have this in place for non-contracted providers based on CMS regulations who participate
• This only impacts PROFESSIONAL claims
• This only impacts MTW markets (AZ, UT, NV, NM and CO). NOT CT

E

100

Maximum hold time for transfers?

What is 5 (FIVE) minutes.

200

B R A V O 

What is how to show appreciation to a co-worker.

300

Orthonet has ended post-pay review of claims as of 6/1/2021.  As a result, disputes on post-pay claims should be treated as standard disputes and worked by?

Who is CORE.

400

Providers receiving electronic payment EFT/ERA (aka ACH or Direct Deposit) that are requesting to view their ERA (EOP) should be directed to?

Who is InstaMed

500

InstaMed's direct contact number for providers?

What is 866-467-8263

S

100

A system we use to verify eligibility with UHC members if they are not coming up in facets or NAMM (CT)?

What is GPS

200

This advocate loves ALMOND M&Ms

Who is DAMION SHEPHERD

300

Tips of the week are posted here?

What is YAMMER

400

The Data Group and Series Designator Number in DOC 360 to look up a check?

What is "Treasury and LFE1"

500

Does Medicare cover Hyperbaric Oxygen Therapy?

What is YES !

_{Medicare Part B (Medical Insurance)}

_{may cover hyperbaric oxygen therapy, if the therapy is administered in a chamber (including a one-person unit) and you have one of these conditions: Acute carbon monoxide intoxication}

•  _{Decompression illness}
•  _{Gas embolism}
•  _{Gas gangrene}
•  _{Acute traumatic peripheral     ischemia}
•  _{Crush injuries and     suturing of severed limbs}
•  _{Progressive necrotizing     infections}
•  _{Acute peripheral arterial     insufficiency}
•  _{Preparation and     preservation of compromised skin grafts}
•  _{Chronic refractory     osteomyelitis, unresponsive to conventional medical and surgical     management}
•  _{Osteoradionecrosis as an     adjunct to conventional treatment}
• _{Soft tissue radionecrosis     as an adjunct to conventional treatment} 
• _{Cyanide poisoning} 
• _{Actinomycosis, only as an     adjunct to conventional therapy when the disease process is refractory to     antibiotics and surgical treatment}
•  _{Diabetic wounds of the     lower extremities if all of these apply:} 
•  _{You have Type      1 or Type 2 diabetes and have a lower extremity wound that’s due to      diabetes.} 
• _{You have a wound      classified as Wagner grade III or higher.} 
• _{You’ve failed an adequate course of standard wound therapy.}