Enrollment
How many months in total does a eligible person have to enroll
7 months
What system we use to reprint invoices
Oneil Onclick
What's needed to submit an appeal
Denied auth
Denial letter
SNF
Skilled Nursing Facility
What is the KA for Address Change
8720
What is the timeframe for OEP and what action can be done in this time
Jan 1- Mar 31 (switch or drop)
Where can we view grievances
MedHok
True or False
We cannot cancel a pending application
False
NPN
National Producer Number
What is the KA for Expedited Appeal
8699
What is the timeframe for AEP and what action can be done during this time?
Where can we view documents sent in by the member
ECHS
What verification is needed to update an address
MBI
OEV
Outbound Enrollment Verification
What is the KA for PHI/POA
6085
List 4 ways how a prospect can submit an application
By using a broker
call in by phone
Online
Paper application
What system/application houses authorization
Evicore
Med compass
True or False
We do not need to re-verify a member transferred from an external department
False
ADA
American Dental Association
What is the KA for Confidentiality
10150
What is the Hierarchy for election periods?
IEP
SEP
OEP
AEP
What system can you use to verify if the provider INN/OON
Rumba
Smart Front End
If a member's plan does not cover a service, what is the next best option.
Refer to RFL
CLI
Continental Life Insurance
What is the KA for DME
10123