Hospital Visit
What are some probing question to ask a member visiting the hospital?
Is the hospital INN or ONN?
Is the doctor/provider INN or OON?
Is it an outpatient or inpatient visit?
What application is used to perform a mock claim?
Facets
What application is used for emailing an ID card?
Nuxeo
What fees are associated with hospital visits?
Copay
Coinsurance
Deductible
What is the purpose of a mock claim?
A mock claim is used when a member wants to know if a procedure is billable, covered, or requires authorization
What is the recommended browser for Nuxeo?
Chrome
Does the hospital visit require prior authorization for member 102800344, if so, who's the vendor and what's the vendors number?
Yes, Utilization Management HCMO
800-672-7897
What tabs are used to process a mock claim?
Claim Processing + ITS> Medical Claim Processing + ITS>Indicative
What are the most commonly used options for Nuxeo?
Search, Recently Viewed, Favorites, Collections and User Settings
What type of deductible does member 102800344 have?
Embedded
What job aid shows how to generate a mock claim?
Create a Mock Claim
What job aid is used to show how to email a member a copy of their ID card?
Outbound Email Service
What is the hospital copay, deductible, and coinsurance for an INN visit for subscriber ID 102800344? (Inpatient)
Copay: $250
Deductible: $2,000
Coinsurance: 20% (member responsibility)
Double Jeopardy!
Perform mock claim:
subscriber ID- 102800344
provider ID- 88862001
diagnostic code- Z000
procedure code- A5512
What template should be selected to send an ID card?
Member Response Email