CLAIMS CASES
Do we process claims that have already been paid.
What is yes, claims team will work but will not be able to negotiate lower cost.
Where you look to see if member has Onsite Biometric and Flu screenings.
What is HA services in MemPHIS?
This is question we ask if they provided cell phone number.
What is SMS consent
If member has symptom and need a PCP where do we send them?
What is clinical
Where do you add member insurance infomation?
What is demos- Benefit Information
If a spouse is calling for member who's name and email is used in case?
What is the member who claims is about.
Member is calling about STD/LTD and FMLA where do we send them?
What is Primary benefits, SAU, NAU and HUB.
The employer or benefits administrator who the member has our services through.
What is Organization?
List of requests member provides to ensure provider can meet their needs.
What is preferences
How can we contact the member electronically if they are enrolled on the MEP.
What is messaging?
What is the name of forms we send to members? What two ways do we send them?
What is Release of Infuriation (ROI's) forms- via email or docusign.
Member calling to make an appointment for screening, where do we do this?
What is go to iClue Member information- Click on appointment tab.
A question we should ask member before they disconnect.
What is there anything else I can assist you with.
What should we get to ensure correct plan information is received?
What is picture of ID card front and back
If a member is calling about benefits where do I look to transfer to correct skillset?
What is the alerts?
We have sent the forms and created Case, how long do we set task for?
What is 4 days.
Can we cancel Biometric appointment same day scheduled?
What is NO, we can't cancel same day as it is closed night before. They can go for walk in but appointments will be taken first.
Who should case be created under if a parent is calling about a child ?(under the age of 18)
What is Child's name
How do we determine the Turn Around Time (TAT) to advise to the member?
How do we see what services the member has?
What is check HA services tab in Memphis or iClue
What information about the claim do we need?
Date of Service:
Provider/ Facility name and phone number:
Amount being billed:
Description of services received:
Issue with the bill:
Member is calling about mental health provider and does not have EAP, where do you send them?
What is Behavioral Health Nurse
If a member has agent and roster profile which do you choose?
What is Roster profile?
What is the template used to confirm receipt of results?
What is verification of receipt of Provider Locator results?
Where do we locate verification code to register for the portal.
What is organization contact page, member contact detail section.