Claims
Where we view PA's and Gap Exceptions
What is ICUE?
This is where we go for our call handling expectations
What is Building Trust through Advocacy?
The FEC can hanlde UBH claims calls? True or False
False
To route to a RA (research advisor) we use this tool.
What is Macros?
if you get the screen pop, confirm this with the member
What is member's name?
The two types of Gap Exceptions
What is Clinical and Geographical?
How to engage Internal Partners within the FEC
What is the Family Engagement Center (FEC) Advocacy?
Plans that the FEC does not support
What is Out-of-Scope Group/Plans?
best practice when a provider doesn’t answer
What is routing to RA?
When making an outbound call to member this is FEC procedure
What is Verifying Name, Date of Birth and Address on File
Where to find a plans claim filing limit
What is AVA?
The Advocacy related to our Dashboard Offers
What is the Proactive Member Advocacy?
These are the expectations for every FEC engagement
What is the Advocacy Pillars?
Every task should have this
What is a case, preferred contact info, detailed notes (5 W's), appropriate turn around time?
This tool gives anyone over the age of 13 access to medical information up to 1 year.
What is PSN - Verbal Release of Information?
Helps confirm what is billed on a claim
What is claim image?
This SOP contains UHCCF, Healthier Lives, Prescription Discount Programs Vendors resources
What is Social Supports and Financial Resources Job Aid?
As a Care Advisor, this is one way we can support our members
What is provider outreach?
What is staying on line?
What is follow-up?
In ISET, When documenting interactions involving multiple members, this is required to ensure proper documentation
What is creating a separate ORS for each member?
CA's must document this in the ORS when receiving a call from a third party
What is name, organization name and phone number?
This remark code indicates an overpayment
What is 70?
The process to assign a Primary Care Provider to member on a policy is found here
What is Provider Referral Advocacy?
The Internal Partner that deals with school based therapeutic services
What is a Care Specialist?
When routing, we must follow this process to ensure it reaches the correct destination or bucket
What is follow the "Document and Route" links within the appropriate process?
This is needed to get medical answers about dependents. Also what can be given without this?
What is a ROI?
General w/No ROI- eligibility info, benefit info and provider status info.
Medical/Sensitive w/ROI- member gets full access as long as dependent approves.