GENERAL
Carelon's Values (acronym accepted)
CDIAL
Accumulators
Deductible
Coinsurance
Copayment / Copay
OOP / OOP Maximum
The turnaround time for Claims Processing as per KM
30-45 Days or Calendar Days
Used to cross-check the provider's network status and is considered the Source of Truth for provider-related information.
Research Provider
Used to check ITS Claims info aside from SC.
Blue2 or Bluesquared
This is the yearly period where members are given a timeframe to apply for insurance.
OEP or Open Enrollment
This is the enrollment period after Open Enrollment Period.
Special Enrollment Period
Definition of ITS
Inter-plan Teleprocessing System
This is the provider’s ID, which is required in order to assign them as a PCP.
PCP ID
These are three AIs used in ISG Chat.
Spark for KM or Spark
AACI
PBQ
Bonus points if a representative will...
Turnaround time for ID Card Request - Digital as per KM.
Same Day
Process of reviewing and revising a claim that has already been processed, often to correct errors, update information, or reflect changes in the member's benefits or coverage.
Adjustment
PCP Change effective date for GA if request is made today.
Today or Anytime
Three tools that can be used to check member's authorization requests.
SolCen or SC or Solution Central
ACMP
Member360
This is what we call the three letters in member's HCID (JQU 050A76292)
Prefix
The benefit period that starts any month of the year and runs for 12 months.
Benefit Year
This is the Action Code for deleted claims.
RDELE
Bonus points if a representative will...
Perform: Sing
This is the use of WCF.
Checking claims correspondence
Ms. A's Complete Name including Middle Name
Angeline Chan Bontoc
OnDemand code to look up Billing Invoice
ISG Individual and Summary Bill Invoices - WPT130
What does the claim Action Code: R00000 stands for?
Rejected
Where do you go to change a PCP in CA Mainframe?
F3 > F3 > F3 > CM
Bonus points if all of you...
Perform: TikTok Dance