Diagnostic
What does PPO meand again?
Preferred Provider Organization
UH-OH! It's a BOMB!
Choose a house now!
That house will receive 100 additional points and you'll be losing 100 points.
It's a gift! Wanna know what's your gift?
It's another turn for you! Now choose a new category and new tile!
Rhonda always says, "a benefit call is always an ___________"
Eligibility Call
TRUE OR FALSE
Precert can be submitted by the member.
FALSE
Now choose a house!
You'll be switching points with that house!
What does AHH means?
American Health Holdings
UH-OH! It's a BOMB!
Choose a house now!
That house will receive 100 additional points and you'll be losing 100 points.
You are lucky! but not too much!
Please choose a number from 1, 2 and 3 ?
1: You'll be getting 200 pts
2: You'll be getting 20 pts
3. You'll be getting 2 pts
What are the 2 Precert Vendors we can usually see in a member account?
AHH & Quantum Health
In Pre-Certification, what does APPR means?
You're lucky! Steal or no Steal?
Steal: Using a randomizer, the house selected will be deducted 300 points.
No Steal: You'll gain 300 points and one other house of your choice!
In Precertification tab in CSI, what does 'Pred' means?
Predetermination
In Precertification section in CSI, what does "Deny" means?
Status of Precertification is Denied.
UH-OH! It's a BOMB!
Choose a house now!
That house will receive 300 additional points and you'll be losing 300 points.
____ is a medical billing term for obtaining approval from an insurance provider for a medical procedure or service after it has already been provided to the patient.
Retro-Precertification
UH-OH! It's a BOMB!
Choose a house now!
That house will receive 400 additional points and you'll be losing 400 points.
Which is not true about Rhonda:
A. She once slid on ice running for the school bus in elementary school and slid clear underneath the bus.
B. She was travelling with her teachers before and got strangled by a monkey on her hair.
B. She was travelling with her teachers before and got strangled by a monkey on her hair.
UH-OH! It's a BOMB!
Choose a house now!
That house will receive 400 additional points and you'll be losing 400 points.
(PRECERTIFICATION)
The Reference # from vendor in CSI is showing AHH*8446763. what do we provide to the caller if they wanted to check the precert information from the vendor?
8446763. We don't provide the AHH*
UH-OH! It's a BOMB!
Choose a house now!
That house will receive 500 additional points and you'll be losing 500 points.
BONUS QUESTION (X2)
4 PLACES WHERE WE CAN FIND THE PRECERT VENDOR
1. ID Card
2. Medical Plan Docs (Last Page)
3. Benefits Grid - Med Plan Intro
4. Announcement Screen
Which is TRUE about Rhonda:
A. She already jumped off a cliff
B. She got bitten by a Hippo when she's a kid.
C. She's afraid of riding a vehicle if the driver is a girl.
A. She already jumped off a cliff
which is TRUE about Bobby:
A. He graduated Suma Cum Laude
B. He Graduated Grade School as Valedictorian
C. He Graduated High School as Valedictorian
C. He Graduated High School as Valedictorian
WOW! WOW! WOW! Choose a not-so-lucky house!
You'll have 500 points from them! Say YEY!