FINANCIAL
In this model, healthcare claims are paid upfront, and then potential errors, overpayments, or fraudulent claims are “chased down” after payment has been made.
What is Pay and Chase?
Where in AVA/IBAAG can you find if second level appeal/grievance is handled by UnitedHealthcare or the client.
What is > Final Claim Fiduciary - CSR View
This follows the medical policies when a clinical review is performed to identify if such a procedure is covered.
It approves services from a clinical perspective; any adjustment is made in accordance with the plan's benefits.
What is Medical Claim Review
This service allows members to interact with independent providers, and other health care providers using an Internet-based service provided by contracted UnitedHealthcare providers 24/7.
What is virtual care
Eligibility letter, provides individual eligibility information and is not to be confused with your summary booklet.
What is COC or Certificate of coverage
This allows for a percentage of the pledge to be contributed by the employer and made available to the member to use at the beginning of the plan year
What is pre-funding
180 calendar days
What is the standard time frame for appeals.
When a claim can not be located in ISET
What is Claim not on File
This benefits describes medtronic series 600.
What is the diabetes benefit
This form allows an individual to grant permission for UnitedHealthcare to mail or discuss a member's PHI to a specified individual.
What is Authorization to Disclose
This is used for medical care is any common/normally used method of transportation, vehicular or otherwise, that allows an individual to access their necessary medical care at a doctor's office, hospital, or equivalent medical facility.
What are FSA/HRA Transportation/Travel Expenses
The denials of pre-service treatment/prospective denials (when the service is not yet rendered) or concurrent denials (when the review takes place the same time the services were rendered, e.g., inpatient stay).
What is Expedited Appeal/Grievance Process
When a member receives an invoice, bill, or statement from the servicing provider for amounts over what UHC identified to be patient responsibility.
What is Balance Billing
Provides pet insurance plans at a discounted group rate through UnitedHealthcare.
What is Ancilliary/ FIGO pet insurance
These letters are issued based on a termination event applied to a member's coverage or when a member begins COBRA coverage.
What is POLC/ Proof of Lost Coverage.
This account is used to pay for daycare, afterschool programs, adult dare care and not pre-funded
What is Dep Care FSA
This is the UNET process if a member needs an address to submit a written appeal/grievance/complaint.
What is sending:
The original claim submission must not be changed to add or remove charges; an adjustment may be required for underpayment or overpayment.
What is a corrected claim.
This process provides Customer Care with the steps to follow when calls are received related to TOC, TOA, or COC.
What is Transition of Care, Transition of authorization and Continuation of Coverage
When a member has a court date within 3-5 days
What is a critical situation
This product is an HRA product where claims are first applied to the deductible, but only up to the employer-determined access point.
What is split deductible
An inquiry of a denied service that requires notification or approval prior to receiving medical/pharmacy care
What is Pre-service denial
This tells everything you need to know about how a claim processed.
What is remark code
Utilize this process when a member has benefit questions around foreign services incurred while traveling or living out-of-country.
What is Foreign /International coverage
What is a call received from a member/provider of a relative, a friend, or a known or casual acquaintance.
What is receiving a call from someone you know