Claims
What does EOB stand for?
Explanation of Benefits
what does DED mean?
Deductible
Where do we document?
CallTrak/BWAA
What does HIPPA stand for?
Health Insurance Portability and accountability act
What do you do when you receive a call?
Greet the MBR/PRV with "thank you for calling GEHA"
What is a CCN?
Claim control #
what is a copayment?
Amount a person will pay
What is GJBB for?
Access the MBRs account
What does PHI stand for?
Protected Health Information
What can you do to set the tone for a call?
What are the two types of forms used for claims
HCFA (CMS-1500) and UB-04
Dental and vision have their own vendor?. True or False
True
When you hit plan refresh what system comes up?
SuperUser
what is an ARF?
Authorization Release Form
How do you close a call with a MBR/PRV?
Thank you for calling GEHA, if you opted in for the SURV it will connect you when we end the call.
What Probing questions can you ask for a claim?
DOS, PRV name, Billed amount
What is Coinsurance?
a percentage a person will pay
How do you go page forward in Jacada?
F9
How do you Verify PHI on each call?
How can you be here be now?
Listen to the MBR/PRV
What are the 4 segments of a claim number
Last two digits of year, Julian date, Reel number, Random 4 digit document number
What does QHDHP mean?
Qualified high ded health plan
What are common reasons to create a tickler?
Pending Documentation, Follow up req, waiting on claim adjustment or reprocessing, Expected Call back, monitoring a case, tracking escalations, reviewing a case
What does Minimum Necessary mean?
The minimum necessary standard requires employees to access, use, or disclose only the amount of PHI needed to accomplish a specific business purpose. Do not share more information than the caller needs or is authorized to receive
Best practice for addressing a caller?
Use their name when you know it, ask how they would like to be addressed