Acyronyms
QHP
What is Qualified Health Plan?
Billing Reprints
Bill Reruns
What is Billing Inquiries?
Doesn’t meet ACA requirements, and cannot be renewed. Subjected to tax penalties! Can be tailored to your time frame and budget.
What are Short-Term Plans or Temporary plans?
A job aid used to help us code our service requests.
What is RMO Selecting Queues in Dashboard?
Established in 1929 and is currently 89 years old.
What is HCSC?
OPX
What is Out-of-Pocket Maximum?
Changing Effective Date
Changing Plans
Adding a Newborn/ Dependent to an active policy.
What are Policy Changes?
Payment from the government directly to insurers to help members pay their monthly premiums. Which essentially lowers premiums.
What is {APTC} – Advance Premium Tax Credit?
A job aid to help us deescalate members in a difficult situation over the phone.
What is RMO Responding to Difficult Inquiries, Escalating Calls, and Appealing Claims?
Established March 23, 2010
What is the Affordable Care Act?
TRACE
What is Total Recollection And Captured Elements?
Terminating an entire policy.
Terminating a single line of coverage.
Terminating a dependent coverage.
What are Policy Terminations?
When out-of-network provider bills a member for the difference between what the provider charged and what the insurance policy paid.
What is Balance Billing?
A job aid used to help us deal with how to properly release PHI.
What is RMO Managing Call Authentication and PHI Release - Guideline?
Established April 14, 2003
What is {HIPAA} – Health Insurance Portability & Accountability Act?
SPICES
What is Smile, Pace, Inflection, Calmly Breathe, Exaggerate, Shorten Sentences?
One-Time {ACH} – Automated Clearing House Payments
Recurring ACH Payments
Direct Pay
Refunds
Misapplied/Missing Payments
What is Payment Inquiries?
A monthly stipend that the PCP receives for having a member - per member- in their care, even if the member doesn’t see their PCP.
What is Capitation?
A job aid used to help us reassign PCPs to our members.
What is RMO Locating PCP Information in RPI?
Established between the dates of March 23, 2010 - January 1, 2014
What are Grandmother Plans?
HHELPPPPMA
What is Hospitalization, Habilitative/Rehab Services, Emergency, Lab, Pregnancy, Preventative, Pediatric, Prescription, Mental Health, and Ambulatory Services?
Members able to change their plans anytime during the year and an unlimited number of times.
What are American Indian and Alaskan Native Members?
Additional time granted to members to pay their share of the policy premium. Timely payments ensure that the member claims are paid be HCSC and also prevents policy termination due to non-payment.
What is a Grace Period?
A job aid used when a member wants to escalate their concerns via social media, the DOI, or an attorney.
What is RMO Using the Assist Line and Resource Line Job Aid?
Established March of 2001
What is {TRACE} – Total Recollection And Captured Elements?