Members/ID Card
How can I see what the member has met towards ded and OOP
what is by viewing the CAT medical accums tab
What Limit will I look at to see if the member has used all of the physical therapy benefits.
What is outpatient therapy?
These are the categories that I would select for Mental health benefit questions. Does not mean the cost shares.
MIDA office, MIDA outpatient and MIDA inpatient
What category would you look at to see the benefits for skin tag removal?
What is the surgery category?
Where can I locate the term date of the policy.
What is the thru date? (This shows the ending of the policy or when it terminated.)
In the CAT search, if it shows prior member ID and gives another policy number, member migrated from what system.
What is Corelink? (The system we now use is Healthrules.)
This indicates which of the member's insurance companies pays first and second.
What is coordination of benefits? (the member alert will appear if there is other coverage, if there is no other coverage there will not be an alert)
How many sessions can a member have for outpatient mental health services?
There is no limit however we would recommend preauthorization for anything more than 90 visits per c/y.
What medical plans have a lifetime maximum that I must be sure to quote.
What is Armor health?
This field indicates the last date an ID card was mailed.
What is the ID card history link in the eligibility tab.
What is under the accumulator tab in HR, outpatient therapy, then click on the retrieve button
ID 100021413 for Todd, what plan is primary for Dental
What is Aetna?
The fist initial visit with your mental health provider is called what?
This would be a diagnostic interview or evaluation
This category definition indicates if there are benefits for Invitro fertilization.
What is infertility?
On the member screen, this specific date would be helpful in completing VOI/VPR.
What is the birthday?
This type of family deductible accumulation means that the family deductible can be met by only one family member
What is Aggregate? (You will find if it is Embedded or Aggregate in the medical accums tab.)
What is the age limit to receive a mammogram covered 100% regardless of diagnosis?
What is 40?
How many days can you remain inpatient for mental health before the hospital needs to contact the insurance company?
All inpatient mental health will need precertification from DAY 1
Why would a plan not list out of network benefits for an emergency?
What is ACA mandates that emergency be processed as in-network regardless of the provider network status.
what is the age that a dependent will normally age off?
What is 26?
What is the difference between Coinsurance Maximum and Out of Pocket Maximum?
What is Coinsurance maximum will never include anything other than the coinsurance percentage? Once that is met the member will still be liable for any copays. OOP max is a worst case scenario, it will include deductible coinsurance max and in many cases office copays
For Dental, what are the steps to see what tooth was applied to a limit for a crown.
What is in the HR accumulator tab, locate the crown limit, click on the retrieve button this will take you to the claim, from here you will need to open the claim > lines tab and the tooth number will be listed.
A psychiatrist would be considered a specialist - True or False
False - BCBS considers all mental health providers as PCP or Primary Care Physicians.
what Category would I look in for coverage of impacted Teeth?
What is Oral surgery?