System
Where do i check Eligibility ?
CPS
what is mandatory information that needs to be verified before providing any types of benefits ?
Provider's info including network Status
Member's info ( name and DOB needs to match )
Claim Control Number
How many claims i can take per call ?
3 claims
what can i skip during claims calls on the verification part ?
Provider Address
Which Platforms do i use to check for claims ?
CPS, Admin, CART, Webclaims
How many ways to read Benefits Information do i have ?
*HPDB
*TOB
*VOB
*DYK for some HP
what basic information do i need to be able to locate a claim ?
member's ID, DOS and BA
If a Provider asks me for a Sup, what should i do ?
let the caller know that a sup will reach them within 24 to 48 hrs, if the caller declines the find an SME to take the call
If the provider is calling me with an outdated ID #, what is the proper procedure ?
try to find the prefix of the id # and advised that for Billing proposes the complete ID # is the 12 digits one
What is the only way i have to see documents providers have sent to the main fax #
Onbase
In which part of HPDB i can find the deductible amount if i am suppose to read benefits from HPDB ?
Schedule of Benefits
How long it takes for claims to be reviewed ?
for General HP it is 30 BD from Received date
For SIA is 45 calendar days from CBD date
if i find 2 attachment dates on cart for the MR which one should i give to the caller ?
Where can i find Just say yes policy instructions ?
which systems do i use to check if a payment have been released ?
CPS, Admin, Check tracer
how many ways i have to fill out a Pre auths and how do i know which one i have to use ?
i have 2 CART and sharepoint, and under special covered services i would have the link i need to use depending on the HP
which systems i can use to check if MR have been requested ?
CPS, Admin and CART
what should i do if a Caller is rude with me or is using unprofessional language ?
provide 3 warnings and then release the call
Which HP ask me to transfer the call for pre auth
IMG ( 76570070 )
List the platforms we have seen up to today ?
* Iset
* CPS
* Admin
* CART
* Onbase
*webclaims
*Check tracer
*remarks code
*Knowledge library
*Knowledge central
*yammer platform
How long it takes for a pre auth escalation to be answered ?
24 to 48 BH or based on HPDB instructions
What is and ICES Denial ? and where can i check info about it ?
it means the billing of one or more codes was not properly done , i can go to Webclaims or CART for further info
how do i handle Ghost calls ?
Do the opening 3 times, said the ghost call spiel and release the call, leave a note in the dummy account to notify why you hung up
Which HP Does not allow me to give Benefits if the service is above $10.000 USD ?
Davidshield