Terms
This is a cost-control process in which physicians are required to obtain advanced approval from a varrier before a procedure.
What is a Pre-Authorization
What is Cobra?
(Don't need to know what it stands for just what it does)
What is a law that allows some employees to stay on their health plans after leaving employer.
The Consolidated Omnibus Budget Reconciliation Act
What do we use ADP for?
What is to manage your time and to request time off.
You met Shanice, what does she do?
What is Shanice is H.R., she introduced you to your benefits and other topics regarding Rightway
Other than water what is the most consumed beverage?
What is tea.
What is the difference between Open Enrollment and Special Enrollment
What is:
Open Enrollment: The period of time in which members can enroll or make changes to their employer sponsored insurance plan
Special Enrollment: Special Enrollment is brought upon by Qualifying Life Events (Job Change, marital status change, birth)
What is EAP
What is additional benefits offered to employees outside of their medical/Dental/Vision. Benefits often include therapy sessions, Gym Reimbursements, Family Care, Legal Services and other "perks"
Employee Assistance Program)
What do we use the advocate for?
What is to build and manage tickets, communicate with members, access other programs etc (multiple answers acceptable).
You met Andrea, What does she do?
What is I.T.
What is the highest grossing video game of all time?
What is Mario
What is a referral?
What is the transfer of care for a patient from one clinician or clinic to another (Referrals are typically done when the necessary care is Out-of-Scope for the member’s provider)
What is a type of savings account offered to you from your employer that allows you to pay for qualified medical expenses (like Dr. visits and over the counter medications)
Health Savings Accounts
What do we use CMS for?
What is Benefits information.
You Met Steven, What does he do?
What is Director of Navigation, he runs the department.
Who was everyone's first friend on MySpace?
Why might someone need a prior authorization?
What is to see a specialist, for imaging, surgical care or prescription medications. (Often it is anything that their PCP cannot handle)
What is PBM
What is Pharmacy Benefit Manager (This is the pharmacy arm of the insurance plan - primarily responsible for paying the prescription drug part of the plan)
What do we use Guru for?
What is process information.
You met Mike Zevoteck, What does he do?
Who was the first singer to appear on the cover of Rolling Stone Magazine?
Who is John Lennon.
What is a Specialty Pharmacy?
What is A pharmacy that distributes specialty medications to members, either via mail order or through a provider or facility (sometimes sent to a retail pharmacy for a member to pick up)
What is a Qualifying Life Event (Marriage/divorce, adopting a child, having a baby, a death in the family, moving zip codes, becoming a U.S. Citizen, leaving jail etc)
What do we use NIC for?
What is send receive calls, manage texts, request time etc.
You might have seen a video with Jordan Feldman, who is he?
In 1995 which MLB team began playing at Coors Field?