GEHA
What is usually the benefit for this health plan?
$2,500
Name TWO oon plans that we mark as No benefit.
..
True or False?
When verifying select you always take the prefix off?
False.
It depends on each plan. Some require you to keep the prefix and some require to take off the prefix.
How do we verify a Humana PT that lives in Florida
We mark them as no benefit and change the partner to "Humana- do not use"
What prefixes should we check if a member ID comes in without a prefix?
QCE, Q1E, HRF, HRT
How often do members that are 19 and older get this benefit?
Every 3 years.
Name 2 of 4 OON plans that we are not partnered with that we ACTUALLY call and gather a benefit for.
-EWTF
-Careington
-NALC
-NRLCA
If there is a caresource.
Which out of the following do we call on?
Ohio
Indiana
Kentucky
We only call on Kentucky.
If the others do not auto verify, we mark them as no benefit.
How do we mark a "Supplemental Policy"
Mark as no benefit and change the partner to "Humana- do not use" And use the follows medicare guidelines note.
How do you mark IBC that is not select that is an HMO
you mark this no benefit and use the HMO note.
How often do members that are 18 and younger get this benefit?
Every year
What is the NRLCA plan name?
Rural Carrier Benefit
What files do we double check group numbers and CMS codes for verifying that a PT does in fact have select?
The matrix
"Currently loaded matrices"
What does a humana ID look like?
H12345678
How do you mark an IBC that is not select but is NOT HMO
Mark this as no benefit must submit their own claim.
What plans DO NOT have hearing aid benefits through GEHA?
True or False?
When verifying MVP, we look for the base benefit instead of the Rider?
False
If somebody does have Select but you are not able to bring them up in the feed, what do you do?
What is the most that we charge for a copay?
45$
True or False?
We mark highmark as no benefit if they do not have select?
False.
This only applies to Independence
What do their reference numbers look like?
190510001234
EXAMPLE: Year,month,day, then the reference
How do you verify a SCAN?
Through the FEED.
HARVARD PILGRIM
Which one is Select and which one is No benefit?
ID #:HP12345678
ID #:H00012345
ID #:HP12345678 - NO BENEFIT
ID #:H00012345 - SELECT
Walk me through verifying a Humana entirely?
Check on availity
Check for Find a Doctor
Check ID Card for CMS code
Check benefits on Humana Booklet
What do you do with the ID numbers to verify as Select?
Take off the prefix and add a 0 at the end