Ambetter
Centene SYSTEMS
Miscellaneous
Ambetter Services
Ambetter Payments
100
A commercial health insurance product with policies for both individuals and families.
What is Ambetter?
100
****************DAILY DOUBLE******************* Where in CRM do you find the SBC?
Within Tools, then under the members SBC tab
100
*************Daily Double**************** Open Enrollment Season for Ambetter starts:
The month of October through December
100
****************Daily Double****************** What dental service vendor does Ambetter use for dental care?
What is DentaQuest?
100
*************Daily Double**************** Payments for Ambetter can be take three (3) ways:
What is: 1. The IVR 2. Call in the payments 3. Mail in payments
200
Emergency Services Outpatient/Ambulatory Services Preventive & Wellness Services Maternity & Newborn Services Pediatric Services Mental Health & Substance Abuse Services Laboratory Services Prescription Drugs Various Therapy Services (PT & Devices) Hospitalization
What is 10 Essential Benefits of ACA?
200
Which system would you use to check a provider's affiliation(s)?
What is CRM?
200
The additional (buy-up option) services for Ambetter members are?
What is Dental and Vision they are buy-up options; (cannot buy dental only)
200
This pharmacy service Ambetter members use for medical RX.
What is US Script?
200
Member's have how many days to make their premium payment without APTC.
What is 30 days?
300
Monthly bill that a member has to pay to have insurance and a member must pay this before they are covered.
What is Premiums?
300
We use this system to check if a provider is listed as a Non Par provider.
What is Portico?
300
Does Provider HIPPA verification requires that verify the provider and the member's information?
YES, (2) Two pieces of HIPPA verification for the Provider; example: NPI and Full name or NPI and TAX ID? And the (3) three pieces of HIPPA verification for the member; example: Name, DOB, Member ID, SSN and Address.
300
For Behavioral Healthcare Ambetter uses this service.
What is Centpatico
300
Member's with APTC have how many days to make their premium payment?
Up to ninety (90) days.
400
******************DAILY DOUBLE***************** List the Health Plan Choices for Ambetter.
Essential Care (Bronze) Balance Care (Silver) Secure Care (Gold)
400
This system is used to process payments
What is e-cashier Emdeon?
400
All tiers can quality for premium subsidies which is:
What is Advanced Premium Tax Credits (APTCs)>
400
What vision service vendor does the member use for vision care?
What is Opticare?
400
Can a provider bill a member while they are in suspended status for non-urgent services?
Yes, a provider can bill a member while the member is in suspended status. They can bill at health plan rate only.
500
Cost Sharing consist of the following:
What is Deductibles What is Co-pays What is Co-insurance
500
This is where you would search for educational updates on Ambetter.
What is SharePoint and the Web Portal?
500
Can a provider bill a member for emergency services?
No, all emergency or emergent services are covered 80% if documentation verifies an emergency.
500
Home Health, DME, and Home Infusion services go through which service vendor.
What is Univita?
500
Members are not considered enrolled until they make their:
What is first time payment or binder payment.
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