Claims
What do we have to make sure we do in the manage claims task after we have reviewed a claim?
Check the box next to the claim
What are the five questions we want to consider when researching benefits?
Who What When Where Why
Member hasn't updated a change to their policy with their company yet
BenefitSolver/HR
"I want to see if I've been approved to start physical therapy"
Manage Authorizations
EVERYONE CAN ANSWER: Name as many planets as you can without googling, one point for each!
Mercury Venus Earth Mars Jupiter Saturn Uranus Neptune (Pluto, I'm counting it still).
If I see that multiple claims are in need of adjustment for the same reason, how many separate claim adjustment task exchanges do I create?
1
Name some examples of sensitive services
Mental Health, Substance Abuse, Reproductive Health
Member isn't sure of CPT codes for upcoming procedure
Provider
"Thank you for reminding me that my immunizations are due soon"
Manage Alerts
What percentage of people in the world are left-handed?
10%
What limit does the subscriber have on receiving claim information about other members on the policy?
Needs sensitive services auth form on file if claim is related to sensitive services
What level of benefits am I going to quote for someone who is going to physical therapy at a hospital
Professional and Institutional
Mbr has a red clinical advisory stating that a clinician has been trying to get in touch with them.
Case Management
"You left me on hold for 4 minutes and that offended me on a personal level, I want to let someone know"
Complaints/Appeals
How much does a cloud weigh?
Around 1 million pounds
3HZN42735710, what service is the claim ending in 2902 with DOS 3/4/20 for?
00811, Anesthesia
What does modifier GT signify?
Telehealth Services
Mbr has a claim with a SCCF number
HelpDesk
"I need a referral for a pediatrician for my son"
Provider
How many years can a snail sleep for?
3 years
What do I click to view the EOB for a specific claim?
The three dots
What happens on an audit if I quote a benefit incorrectly or incompletely?
#Fail
Member's call drops before you are able to assist them
The Member
"I've been diagnosed with diabetes recently and am wondering what resources are available to me"
Manage Referrals
What is the only continent without an active volcano?
Australia