Benefits and Eligibility
What needs to be read when pulling the B&E intent?
What is: red disclaimers
What action do we take if we provided only general claim status to the provider?
What is: reviewed
Intent used to document simple request for providers.
What is: Provider Request Intent
True or False: We can submit a Provider Relations call back request through the COB intent?
What is: False
That would be done through the provider request intent
The blue disclaimer is for...
what is: you (instructional text)
Which action do we take if the provider wants to send the claim back for reconsideration?
What is: Dispute
the COB intent is used for...
Where do we document member not found and provider not found?
What is: Log View Status intent
To navigate to the benefits screen, which question do we select yes to?
What is: Does caller need benefit information.
True or False: RRR is only used for paper checks
What is: True
Intent used to document a provider's complaint.
What is: Issues Intent
True or False: We pull the claims intent to check on the status of an authorization.
What is: False
We pull the Medical Authorization Inquiry
What other resources can we use to quote benefits?
What is: the member or provider handbook.
What action do we initiate if a provider wants to know why they have not received their check?
what is: RRR (recovery, refund, and returned check)
Intent used to document member not found, provider not found, or fraud, waste, and abuse.
what is: log view status
In the Care Management intent, for the "Service Request" we select...
What is: case management team