New Enrollment
ONX Process - Do we still need to confirm ONX Enrollment status/date of ONX members?
No, use date on the member's plan as the effective date.
Give the 4 scenarios wherein we void the supply order.
Member is for discharge.
Member is for CoC.
Member is under TPA/Homelink/EP.
Duplicate supply order.
How do we handle Champ VA account in ICF?
Verification will no longer be needed. ACH is moving forward as Unable to Service.
Once we were able to verify the insurance, the CB status should be updated to this status.
Active Status
What is the name/ brand of Kirstie's online shop?
MK Online Goodies.
In the current VOB Process, the only time we’ll update the Program Status to “INACTIVE” is when we’re offering Self-Pay or Unable to Service for a New Enrollment and Reactivation accounts.
True.
Give one insurance that we do not handle and are being assigned to LIV Team.
Capital Blue
Care N Care
1199 SEIU Funds
Medical Associate
Medical Mutual (Primary)
Health EZ
Clover Health
UPMC
UCLA Health System
UCLA Medical Group
Do we create a CB for Self Pay (Primary)?
No.
Give one insurance that we do not handle and are being assigned to LIV Team.
Capital Blue
Care N Care
1199 SEIU Funds
Medical Associate
Medical Mutual (Primary)
Health EZ
Clover Health
UPMC
UCLA Health System
UCLA Medical Group
How may siblings does Marc have?
3
Give one insurance that we do not handle and are being assigned to LIV team.
Capital Blue
Care N Care
1199 SEIU Funds
Medical Associate
üMedical Mutual (Primary)
üHealth EZ
Clover Health
UPMC
UCLA Health System
UCLA Medical Group
When working on Pre-Authorization Follow-Up Task and the Authorization was approved without a need for LOA, the PA Case outcome must be set as “Auth on file” and not “Order Activated?”
True.
How do we fill out CB for Secondary Tricare for Life insurances?
Supplement/ Tricare For Life/BS Federal
Network – Yes
Contracted Provider – ACH
For RA Anthem Plans, we verify G0248 and G0249.
False.
Please recite our voice mail scripting.
HAHA
This is where documentation goes to communicate to other Members of VOB regarding insurance/payer calls.
Service Case Description
This is the case outcome if we need additional insurnce information from the member.
VOB Call Needed.
What do we do if we identified that the new insurance reported is a TPA?
If determined on call that Insurance is through a TPA provider, update the Primary Payer Plan to the TPA insurance, leave the Status in Draft. Secondary insurance is the true insurance plan and, leave the Status in Draft,
In the current VOB Process, the only time we’ll update the Program Status to “INACTIVE” is when we’re offering Self-Pay or Unable to Service for a New Enrollment and Reactivation accounts.
True
What is my favorite color?
Pink
Where do we put our notes if account is for Insurance Discrepancy?
Program Case Activities.
How do we handle Medica plans in Supplies Task?
Update to VOB Management Review.
This s the case outcome if we need additional insurance information from the member.
VOB Call Needed.
No. Only G0249.
How many girlfriend does Jerica have?
HAHAHAHA too many to mention!