Intro to Claim Status
Who is automatically authorized on a claim?
- Parents of underage/minor children
- Power of Attorney
- Executor of Estate
- Someone named by the claimant
What should you do if you notice that the Assistance Status is open on a claim?
Transfer to EC
If we aren't able to find documents in GoTrex, we can look for documents in ______ & _______.
Outlook & EDMS
What are the Communication Notes written by assessors called?
Case Summary Notes
What's the task that we use if someone wants to close their claim?
Category: Claims Assistance
Template: Close Claim
Assign to your TL
Click OK
What does VOC stand for?
Verification of Coverage
What's the difference between tasks that are green and tasks that are black?
Tasks that are green are completed and have been actioned. Tasks that are black are still open and awaiting action.
What resource can we use if we aren't sure what type of task to make to trouble shoot an issue?
The Problem Solver
Which 3 tabs GoTrex can could you potentially find Documents?
Communications tab, Documents tab, Bills tab
What task would you create to update a claims assessor of important information regarding a medical claim?
Category: Claims Assessment
Template: Claims Assessment F/U
Assign to the assessor working on the claim
Click OK
True or False - you do not need to document a call if someone just asks for the fax number.
FALSE! All interactions must be documented in GoTrex.
What are the various bill statuses?
Pending, received, underwriter invoiced, cancelled, settled.
Which Navigator page will give you information about the various VOC statuses?
Claim Status Guidelines Page
Case Note - Assistance Note
What's the task that we'd create if a member requested a supervisor call back?
Category: Quality Management
Template: Supervisor Call Back
Save & Auto Assign
What types of information can be provided to all callers (whether authorized or not)?
Scripts, policy wording, test/visit approvals, non-specific claim status information, claim form instructions, GEM's contact info
What types of reimbursement methods does GEM offer to claimant's for out-of-pocket expenses?
Cheque, e-transfer, direct deposit.
If you forget how to authorize someone, which Navigator page can you review?
Confidentiality & Privacy Guidelines
The GEM Medical Certificate is requested when a member cancels their trip due to medical reasons. It's a document that must be brought to the patient's primary physician and signed by them in order to confirm that the medical condition was unexpected and severe enough that the physician advised against travel.
What task would you create if a member with a non-medical claim called in and said it's been 30 business days and they still haven't received their reimbursement?
Category: Finance - GEM
Template: Trace Payment - Not Set
**link the bill to the task**
Save & Auto Assign
What type of note needs to be added to a claim if we are authorizing someone?
Special Note - Authorization for disclosure of Personal Information
How can you tell if a bill has been paid?
The status will be settled and there will be a monetary value in the "paid" section of the bill
Using the Appeals Guuidelines page, can you tell me which e-mail address members should send their appeals to?
customerrelations.mailbox@globalexcel.com
What components are necessary on a cancellation invoice?
-Must come from the travel supplier
-Must have the cancelled travelers names
-Must include amount refunded/credited (including any penalties)
-Date of cancellation
What task would you create if the claimant calls in and says they are being sent to collections for a bill that GEM has?
Category: Provider Support
Template: Contact Provider to place account on hold
Save & Auto Assign