Facets Wave Review 1

Products

100

These products do not require Referrals to see Specialists.

PPO, Local Plus, OAP

200

What type of product Includes a reimbursement account for that the customer can use to pay for eligible healthcare expenses?

Consumer Driven

300

This or these products do not require a PCP or primary are selection.

OPA

PPO

Local Plus

Coverage

100

Which pieces of information does Cigna use to Determine Coverage. There is more than one answer here.

What service the customer is receiving

Why the customer is receiving the service

where is the service being performed

200

If you wanted to view a customers Accumulation such as skilled Nursing Facilities or Therapies where will you go to view these.

in Facets Limits Tab

300

This type of deductible is one where the individual can meet their deductible and then be in co Insurance or the family can meet the family ded and the entire family be in Co-Insurance?

NON COLLECTIVE

400

This type of deductible states there is not cap on the amount and individual can meet on a plan, but the entire family deductible must be met before the Entire family is then in Coinsurance. The Individual deductible does not matter here.

COLLECTIVE

Eligibility

100

Using our systems show was where to find the customers Effective and term dates. 

Facets: 

OneView:

200

What system do we use to see updates and information Eligibility specifically the COBRA end and start dates.

Facets

300

Name one event that qualifies as a life event to qualify for change and addition of insurnace.

Birth or adoption baby

change in marital status (married or divorced)

Death of Policy Holder

Aged out of plan (26 or 30)

Correspondence

100

True/False: When a caller sends correspondence to Cigna Via mail or fax for a facets customer, these documents are loaded into a system called iView.

False.

They are loaded into FileNet

200

True/False: Only Contracted Providers can use CingaforHCP.com

FALSE

300

As an Alorica GSP agent do you have the ability to Fax?

If not what is the process you take to get a fax to a provider

No, we would collect the information to send the fax and send that with the info attached that needs to be sent either Co facilitator and they will fax them to the provider on our behalf

HIPPA

100

Name 3 Things that are considered General Information.

Cigna Address information

Participating Status of a provider

Drug Lists.

200

what system do we use to see if the customer has a privacy authorization on file and please navigate us to that area.

One View

Under HIPPA tab

300

Which Caller Type are we able to disclose the customers Date of birth to? There may be more than one answer. 

The customer on the account

Health Care provider

Custodial parent of Minor child

Employer

None of the Above