SIMS
This is created every time an interaction takes place
What is a case?
This houses links to all SOPS/Job aids used in global insurance
What is the GI Member Services Core Index?
This service can either be embedded into the medical plan or standalone
What is vision?
We can search these three things for international plans
What are members, providers & claims?
This needs to be added in every case to capture member info, benefits, and providers
What is API data?
This job aid assists you with what you need to document in every call
What is the member services documentation job aid
This is the pharmacy vendor for all global insurance plans
What is Optum RX?
When using the global hub for providers, this is something we never do
What is add a provider?
This is created when an issue needs to be routed to claims or the GET team
What is a DR?
This resource help with quoting benefits
What is the benefits and coverage advocacy?
These are submitted on the domestic side typically by the provider to approve medical services/procedures
What is a prior authorization?
This section gives us member info such as address, contact info & payment info
What is the member details page?
This is the section in the case where you enter detailed documentation on what happened in the interaction
What is the Note?
This resource is where you will find the seven rules of COB
These are created by us or the clinical team when necessary to ensure a provider/facility is paid when services are done internationally
What is a GOP?
If you don't have the global hub claim id you can use this to search instead
What is the iset claim number?
For documentation to be considered complete this needs to be entered and saved in the members plan in iset
What is the SIMS case number?
This resource can help troubleshoot claims
What is the claims advocacy?
We work with this team when members are frustrated and request a supervisor
What is the GET team?
It is important to look at this section in the provider details page for special instructions
What is the notes section?