Eligibility
Where can we find the member's effective and termination date?
From the members policy line.
Where can we find the image of the member's I.D card?
The member's I.D card in the policy details section.
Where in the highlight panel do we click on to load the members benefits?
Plan Benefits
What type of services are covered under Medicare Part A?
Inpatient care, SNF, and hospice.
What is A.P.R.I.L?
" A Path to Research information and Link" This system will be used at the start of each day.
What source code will we be looking for in spire?
AP= Community and state
What card allows us to check if the member has a current Lock-In status?
The Lock-In history tab in the member details section.
Which plan type is always the payor of last resort?
Medicaid
What is Medicare Part C, and what services are covered under it?
Medicare Advantage. Services like Dental and Vision are covered under this benefit.
What does HMO and PPO stand for?
Health Maintenance Organization, and Preferred Provider Organization.
Where can we locate the providers specialty?
It is located in the highlight panel.
How can we see if the member has any other members listed in the household?
It will be listed in the household section in spire.
Where can we locate how many physical therapy benefits the member has used?
It will be located under benefit accumulations.
What type of plans are TANF, and CHIP?
TANF= Temporary Assistance for Needy Families, and CHIP= Children's Health Insurance Plan
What should we verify at the beginning of every call to ensure we are within HIPAA regulations?
We should always verify the providers name, members name, and the members date of birth.
Where can we find the members UHC subscriber I.D number at?
From the members policy line.
Where can we see if the member has another insurance as their primary plan?
Located under the COB history tab.
Where can we find the group number for the members plan?
Located in the highlight panel.
What type of deductible and out of pocket will the member have if they have a Medicaid plan?
The member will not have pay either or if they have Medicaid as the primary payor with us.
How can we determine if the provider is INN or OON?
It will be listed under "status" in the highlight panel.
What indication will be showing in spire if the members plan is no longer active with us?
There will be a RED "X" present to indicate that the plan is no longer active.
Where on the Snapshot page can we find the member’s DOB and age?
Under Member details
How can we locate the patients responsibility in spire?
It will be listed under the plan benefits, and it will show any type of cost share, or copay listed.
What does Part D Medicare cover?
It covers the pharmacy, Drugs, Etc...
What does PCP stand for?
Primary care physician.