CSR Contact Handling
This is the goal of CSR agents when handling provider inquiries.
What is resolve all cases on the first call (or contact)?
You need this many criteria to submit TPL information through the DC Web Portal.
What are two criteria? (Such as DOB and SSN)
This number of criteria must be entered to search for a member when submitting a new claim.
What is two criteria?
You should recommend downloading the full fee schedule instead of using the inquiry tool only in this situation.
What is when needing multiple codes or when needed for offline access?
32 degrees in Farenheit is this in Celsius.
What is 0?
This AUX code should be used when attending a training session.
What is Training?
This is the purpose of the Global Toolbar in the DC Provider Web Portal.
What is to access help, language settings, and user profiles?
This group is covered under the DC Healthcare Alliance Program.
Who are residents not eligible for Medicaid?
This is the typical error rate for paper-based Medicaid claims processing.
What is 15-25%?
Between 1950 and present day, this is the month with the most recorded tornado touchdowns in the United States.
What is May?
A CSR does this in the system with inquiries for resolution and tracking.
What is documents the inquiries?
This is the primary purpose of Coordination of Benefits (COB) in Medicaid systems.
What is to manage multiple insurance coverages for a beneficiary?
This is a benefit of using Electronic Data Interchange (EDI) in Medicaid claims processing.
What is claims are adjudicated in real-time with reduced error rates?
This tab allows you to search claims by patient account number and claim ID.
What is the Claim tab?
These are the flat, pancake-like clouds that can cover the entire sky, like fog.
What are stratus clouds?
This team handles escalated issues with claim edits that CSRs cannot resolve.
Who are Claims Resolutions Specialists?
This is why accurate data entry is critical when managing COB enrollments.
What is it prevents claim rejections and delays in reimbursement?
Children are eligible for DC Medicaid up to this percentage of the Federal Poverty Level.
What is 319%
If a code like 99499 is not found in the Fee Schedule Inquiry tool, these should be your first steps.
What is check for typos and confirm DC Medicaid coverage?
This is the halo that often forms around the sun when it is low on the horizon.
What is a sun dog?
An example of this would be transferring calls within your skill set without attempting resolution.
What is call avoidance?
This happens after a successful TPL submission.
What is the fields become non-editable and a confirmation appears?
This EDI transaction allows providers to verify patient eligibility in real-time.
What is EDI 270/271?
The Fee Schedule Inquiry displays this only for code 99213 with modifier 25.
What is the base rate only?
This country is the lightning capital of the world.
What is Venezuela?