IBA Vocabulary
What is Client Information
Who we send the claims to
In Network
A provider that accepts the customers insurance
What is the name of the company
IBA
what does COB stand for?
Coordination of benefits
true or False
Snakes can predict earthquakes
True!!
What is a subscriber
who owns the policy
Out of Network
Provider who does not accept the customers insurance
How would we find a doctor for the customer
We would go to Multi Plan and find a provider
What type of plan is indicated if the deductible is 0 and there a a lot of 9's in the plan info
reimbursement plan
True or false
The "Mona Lisa" has eyebrows
FALSE
What is the Claims History
A list of all of the claims we have received for a customer
What are the 5 W's
Who,What, Why, When, where
Who do we call for Pre Authorization?
American Health Holdings
Why would a claim need to be pre authorized?
If the member has a short term plan, all inpatient hospitalizations, and procedures done at an outpatient facility
True or False
Hot water freezes faster than cold water
TRUE
What are Claim notes
Documentation of everything done on a customers account
What is the CRM Record number
The number that associates an agent to a specific call
What is the number for American Health Holdings?
866-790-4177
What does Ancillary mean
Its a specialist
True or false
A hippos mouth can open wide enough to fit a sports car inside of it
TRUE
What is an Audit trail
How/When they processed the claim
What do we find in Masterfied Maintenance
Any Documents that we have IE: Medical Records
What is the name of the 4 plans we deal with?
Lite 1
Lite 2
Traditional 1
Traditional 2
What are the 4 questions that you will be asked most?
1 Benefits and eligibility
2. Claim status
3. medical records and documentation
4. preauthorization
what can a child make but not see
Noise