HIPAA
What is the meaning of HIPAA with year
Health Insurance Portability and Accountability Act
When checking the ID card status and PDF copies, this is the tool that we use
Clarity
Small groups or individual members (new or renewing) who enrolled directly with the organization in 2014 not through a federal or state insurance exchange
Off-Exchange
Used to review applications, research initial and missing payments. (Full acronym)
Integrated Enterprise Enrollment Engine (IE3)
Refers to any type of payment from member that is unprocessed, partially processed, or unreleased.
Unprocessed Cash (UPC)
Two types of Informal Representative
Inferred Informal Representative
Turnaround time for the member to receive the ID card via mail
14 Calendar Days
Tools used to process one-time premium payments by consumers
Anthem Payment Tool
In which part of the Unified Desktop are we seeing the PCP information?
Member Composite Screen
Meaning of "E" in CARE
End with a lasting impression
Internal tool that we use to check whether the information that the contact is asking for can be disclosed
HIPAA TOOL
Hipaa verification and disclosure guide
A demographic can be requested in the following ways
Through telephone/over the phone
Written Request
Code if the bill has generated and the system is waiting for payment
RECEIV
What's CPSUI use and acronym?
Used to updated member's demographics and preferences (Contact Preference Shared User Interface)
What DIA-SCAN stands for?
Diagnose, Identify, Assess
Verbal Pause
Solve, Communicate, Assure and Next step
3 key elements to collect from the caller if it's not validated
Full Name
Member DOB
Give individuals who can request for a demographic Change
Member
Member's Personal Legal Representative
Member's attorney
Group health plan sponsor
Any person identified orally/writing
Company Brokers or Sales Agents
4 types of payments
Initial Payment
Monthly Payment
Non-Validated Payment
Automatic Withdrawal Payment
Give at least 5 tasks that we are using in UD
Member Demographics, ID Cards, Enrollment Billing and others....
What does LOS stand for?
Local Operations Scorecard
This is where we check whether if the caller is listed as an authorized representative (full acronym)
CIRS
Give at least 5 demographics/preferences that can be updated for Commercial LOB
Member's Address
Member's Phone#
Email Address
Contact Preferences
Race and Ethnicity
Gender's Identity
Language Preference
Meaning of COBRA
Consolidated Omnibus Budget Reconciliation Act
Give at least 3 parts of member composite screen
Member's Information
Address and Contact Information
Digital Information
Primary Care Physician Information
Attributed Provider Information
4 member responsibilities in health insurance journey (out of pocket payments)
Deductible
Co-insurance
Copayment
Out of Pocket Maximum