Claims
Alphabet Soup
Benefits
Potpourri
Doctor Hollywood
200

Regarding Blue Squared, this line gives the payment of the claim information non-allowed amounts, and patient responsibility.  It’s the MOST used line on B2.

DF

200

PHI

Protected Health Information

200

Name 2 services that members with Medicare primary will need to get an authorization for through Anthem as FMCP will pay as primary.

Home Infusion, Hearing Aids, Routine visits

200

After the date and work local is found on ERTS, click this to look at the report to locate the member.

The number highlighted in Report Id column

200

Benedict Cumberbatch plays this Doctor in the Marvel Universe movies.

Doctor Strange

400

This is where you go in V3 to check deductibles.

Accumulators

400

ACA

Affordable Care Act

400

Our online behavioral therapy service is through this vendor.

TalkSpace

400

A member is already receiving disability credit hours and disability checks for one condition He wants an additional 26 weeks of pay for another condition to have back to back disabilities.  This needs to be done in order to make this possible.

A member can get a second disability but only if he/she returns to work for at least 1 full day.

400

You may call this Doctor if you cannot figure out what is wrong with an animal.

Doctor Dolittle

600

Item edits that are highlighted in blue means this.

The edit has been overridden by a processor.

600

AD and D

Accidental Death and Dismemberment

600

This is the program member's should use if they have medical expenses while traveling outside the U.S.  Be specific.

BCBS Global Core Program

600

A retired member recently divorced but is now remarried and now he wants to add his new spouse to his plan.  This is the answer the advocate should give.

A retiree cannot add a spouse to the plan after he retires if they were not eligible at the time of retirement and did not lose their primary coverage.

Dependent children cannot be added at any time.

600

This Doctor says things like "Why make trillions when we can make billions?" and "Why must I be surrounded by frickin' idiots?".  He also has a cat named Mr. Bigglesworth.

Doctor Evil

800

This is the denial for a claim that requires pre-certification, but does not have one. Be specific.

Medical Records Required

800

ERTS

Electronic Reciprocal Transfer System

800

MetLife’s group number for FMCP members.

304133

800

This is the piece of information that is not required to be obtained for a RETIREE member that passes away that we would need for all active members.

If death was natural or accident

800

This doctor has no bed side manner and a limp, but will have you diagnosed and fixed up in around 42 minutes.

Doctor Gregory House

1000

This is what is means when there is an IP in the claim alert.

It is a local/Anthem state claim.  It cannot be looked up in B2.

1000

COBRA

Consolidated Omnibus Budget Reconciliation Act

1000

For the first 30 months of dialysis, ________________is primary and ______________is secondary.

FMCP, Medicare

1000

After verifying the member qualifies to make a self-pay, this should be checked before quoting the self-pay.

Check for credits on the account

1000

This Doctor has two hearts, hails from Gallifrey, and has a Time and Relative Dimension in Space machine.

Doctor Who

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