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Used to research claims and for a claims adjudication system.
What is the COSMOS (Comprehensive Online Software for Management and Operational Support) Claims Sharepoint
Used for escalated OptumRx issues such as mailorder and pharmacy claims.
What is the Pharmacy Ops Intake Sharepoint
Used for DMR requests, and travel & lodging requests
What is DMR Sharepoint?
This SharePoint is used to have a member’s PCP updated that as a SAM we are not able to update.
What is the PCP Urgent Issue Resolution Sharepoint?
Used for questions regarding benefit configurations, benefit change requests, and questions about deductibles, copays, and benefit limits.
What is BCCI (Benefit Configuration Case Installation) Sharepoint?
Used to send replacement reloadable cards for completing an annual physical or wellness visit as a reward incentive.
What is the Renew Rewards Escalations Sharepoint?
Used for reporting legal and/or suspected fraud risks.
What is the Legal Risk Management Sharepoint?
Used to resolve medical coordination of benefits issues and inquires.
What is Enterprise NOW?
Used to assist members in locating willing/deemed providers and educating those providers about the way the NPPO/PFFS plans work.
What is the PES (Provider Education Specialist) Sharepoint?