Billing and claims
What are the different claim status you may see. What do each of them mean. What KA did you use.
01,11,15= pending. 99=sent back for correction. 91=adjusted and reprocessed. 02= paid or denied. KA-01552
Do we offer a gym membership for members.
what KA is used for this
if certain things are needed to get this what are they
While its not for everyone- we do offer YMCA which has benefits and more of a gym.
KA-01491
Ohio Medicaid members with chronic conditions and/or behavioral health diagnosis.
*** regular gyms are not included***
what is our member service number
what is IT numbers
what is FMLA number
give me the time frame for occurrences.
meaning .50 occurences is given with how many hours. .25 and 1 full occurence is give with how many hours.
800-488-0134
937-531-2950
844-357-2010
Arriving Late/Leaving Early 00:08:00 up to 0:59:59 = .25 of an occurrence
Arriving Late/Leaving Early 1:00:00 up to 3:59:59 = .50 of an occurrence
Arriving Late/Leaving Early 4:00:00 or greater = one (1) occurrence
when was CareSource founded
DME stands for what
Durable medical equipment
What is the rule when a member calls in to report multiple bills, meaning how can you report them. (one case, each has a case). give all details and include the KA used to find this.
what KA is used for this and explain what the program is
Life services
KA-01486
KA-01501
We will pair you with a life Coach who will help you to work through barriers to employment, housing, transportation (rides), food, education and more.
Occurrences are counted in a rolling 12-month period and expire 12 months from the date of the occurrence.
Based off the amount of occurrences you have, their may be a corrective action.
this takes place when you have 5,6,7 and 8 occurrences. Tell me what the corrective action plan is for each
5 Documented Coaching
6 Written Warning
7 Final Written Warning
8 Termination
How many members do we serve in OH Medicaid
1,052,806
when searching for providers you must also check for what
to see if a referral is needed
Tell me the information you would get from the member to report the bill.
what is the name of the interpreter services we use (the main one). Also provide their phone number and access code
How long do you wait for someone until you call the next interpreter service
Language line. 800-523-1786. 430.
2 mins
Every year in March the company gives out their AIP bonus to eligible employees.
what is the eligibility requirements
An Eligible Employee is an employee of the Company who: 1) is employed with the Company on the Payment Date (defined below), including those on a Company approved leave of absence; 2) has a date of hire, based upon the most recent date in the HR system, that was prior to October 1st of the AIP Year; and 3) is in good standing with the Company during the AIP Year and on the Payment Date.
How long do they advise you have to be here before upskilling in another line of business?
How long do they advised you have to be here before applying to other departments
6 months
12 months
What are the limits to chiropractic care
chiropractic services need prior authorization after 30 visits in a year if you are younger than 21. Prior authorization is needed after 15 visits in a year if you are 21 or older.
How long does a provider have to submit a claim.
How long do we advised for a resolution once submitted for review.
what is step 7.
the bill is behavioral health related with a program, what would you do
365 days
60 days
ASK: the member if they signed a waiver of liability for services.
If they have OH rise get them transferred to Ohio Rise
what KA would you use if a member calls in for a free phone.
what do they get with this.
whats the name of the service provider for this
01522
entouch wireless
As an employee CareSource offers Discounted tickets to places. name 3
any 3 is fine
How long is ACW
what is SL meaning
what is ASA meaning
after call work- 1.30
sl= service levels
ASA= average speed of answer
if you dont locate the benefit you can ask for what
benefit grid and PA list
cpt code
A member calls in with a denial of a service.
this is not a bill but they show the claim was denied.
what KA would you use. What is this called. and what steps would you take to assist them
KA-01097- Notice of action-
CAPTURE AND DOCUMENT: the type of service for which the member received the NOA.
EDUCATE: the member's right to file an appeal.
ASK: if they want to start the appeal process.
what KA is use for adult rewards
How long until rewards are received
How much can they get for dental rewards
what is the only time they can get a physical card
KA-02122
60 days after paid
$20 twice a year total of $40
no internet access- phone, family/friends/library etc
Our Mission
To make a lasting difference in our members’ lives by improving their health and well-being.
Our Vision
Transforming lives through innovative health and life services.
Our Values
How many questions is the survey at the end of the call
3
A member needs to see a specialist but there are none within 50 miles, and we can not locate any. This causes what
access issue