Tools
What are the tool we use to check provider participation?
GPS, Rumba, HRP and SFE.
Other terms for Internal Medicine, Primary care physician and Family Practice.
General Doctors
Accounting for about 80% of the brain's total volume, this largest part of the brain is responsible for higher-level thinking and speech.
Cerebrum
It allows member to switch and drop.
Open Enrollment Period
What is CMS?
Center for Medicare and Medicare
Tools we use to check status of Authorization.
Medcompas and Evicore
Small growths or clumps of cells on the lining of the large intestine.
Polyps
This part of the body is called the collar bone.
Clavicle
It allows member to join, switch and drop.
Annual Enrollment Period
What is the other term of Pre-authorization?
Pre-certification.
Tool we use to check status of enrollment and reason of disenrollment.
Market Prominence
A primary care physician who specializes in the health, prevention, and treatment of medical conditions in older adults
Geriatric
Half of your points will go to ?
Group 1
What requirements must member meet before enrolling in a Medicare Advantage plan?
Medicare Part A and B
A medical device which replaces all or part of an internal body organ or an external body part lost or impaired as the result of disease or injury.
Prosthetic
We used to check premium invoice and Premium payments.
Oneclick
Half of your points will go to....
Group 3
This light-sensitive layer of tissue lines the back of the eye and sends visual signals to the brain.
Retina
While cancellation means the member stops enrollment before the plan becomes effective, enrollment means the member keeps the enrollment and coverage starts on the effective date.
True
The practice of medicine dealing with (but not limited to) the management of procedures for rendering a patient insensible to pain and emotional stress during surgical, obstetrical, and certain medical procedures
Anesthesiology
What tool do we use to file an appeal?
Star Central Portal and Quickbase
What type of specialist treats/diagnose colon cancer?
Gastroenterologist
Smallest bone in human body.
Stapes
It is a printed documents that helps members review and compare their current year's coverage with next year's coverage so they can decide whether to keep their plan or choose a different one
Annual Notice of Change (ANOC).
What is the Parent company of Aetna?
CVS Health