HIPAA
Someone who is able to get detailed information on an account, but requires paperwork-
What is an POA
What are the 5 W"s of grievance Documentation
Who what where when Why and How
How to access benefit information for members
Solutran website https://psp.solutran.com/logon/login#/login
Where to locate the Claim address Maestro-
review medical claims sections on summary tab
Where do you find an MCO for a member who is disenrolled
What is Marx
what info can we give a Broker
Share Basic Information without authentication. This information is publicly available.
Do we file Medicaid grievances
No
where do we go to verify who the vendor is
EOC or Wellness Tab
Where to locate the PA Auth phone #
well med #s in SOP CSP Facets Delegated Medical Groups - WellMed Texas
website for Submitting and tracking requests
What is the EWD Portal
What must we verify before speaking to a caller
what is first and last name, month and year of birth
What other things have to be done for transportation grievances
What is email the vendor
How does the member get access to their benefit b4 the card is mailed
Downloading the
mobile app
Who does medical appeals
UHC handles all
What is the SOP that tells us what we are to put in wrap up
System Process - Wrap Up Interaction KM1005177
When member gives verbal permission, what can we disclose to an auth rep.?-
All or exactly what the member has clearly given permission for
What are the 3 main SOP used for Grievances
3 main SOPs- Grievance Handling , Wellness Benefits Transportation, Grievance Categorization
Customer Service Number-
what the agent # 855 395 6597
What SOP for WellMed-
CSP Facets Delegated Medical Groups - WellMed Texas
what is Skilled care
OT, Skilled Nursing, Speech, PT, Day Care Services
What SOP do we go to in order to review info that can be given out?
Hipaa Index
KM1007482
When opening other intents to assist the member please put the P- # in the resolution ie locate a new provider, looking up claims
True or False
False
where can we look if Member is not sure what items can be ordered
what is the catalog or SOP
Solutran - 2022 OTC + Healthy Food Benefit KM1302200
What phone # would we provide to a dr office for a claim
800-550-7691
covers Custodial care as a general rule unless you check benefits
Medicaid