TOOLS
This is used as an emulator of members' online accounts.
Smarthelp / APP / Associate Productivity Platform
In adding a dependent in an INDIV On Exchange plan, this is our process.
Refer to Marketplace
Formal expression of dissatisfaction.
Grievance
These are what we ask for HIPAA verification.
First & Last Name
Member ID
DOB
Company code for AB2470
200C
In what tool can we view member's invoice, tax forms, and other correspondence?
OnDemand
This is the type of family deductible where family amount can be satisfied by any combination of family members
Non Embedded
Kind of grievance that must be resolved within the end of the next business day.
One Day Grievance / OEG / ODG
When updating/ changing an Off Exchange SG policy's address, we refer to their Employer.
False // We can update via Manage E&B Task
Payment window for approved AB2470 Reinstatement.
10 Business Days
This is a tool used to check status and details of Appeals / Grievances aside from SC
NEXTGEN
Cancelation codes we can reinstate
7, 8, 11, 13, 97
Standard Grievance resolution timeframe
Within 30 calendar days
Bonus points if a representative....
sings a ngongo version of Ang Aming Bahay
Fine for every error.
$7500 per error
We use this to change OH mainframe and CA mainframe password.
Avatier
Who is Carelon Global Solutions' President (US)?
Rajat Puri
Bonus points if 2 representatives will...
Do DramaRama
This is the turnaround time for Cancelation requests we provide to the member.
3-5 business days
Name when we need to send an ODG letter and advise the member that we will send them a letter via mail (4)
Referred to employer
Referred to marketplace
Missing claims / Claim not on file
Missing authorizations
Bonus if one representative...
sings Bahay Kubo but all S is replaced by T
Example: Bahay Kubo kahit munti ang halaman doon ay tari-tari
Difference between Administrative and Clinical Grievance.
Administrative: Dissatisfaction related to quality of service from provider / Anthem.
Clinical: Dissatisfaction with clinical care by provider.
What do you call the claim form for professional claims?
CMS 1500
Verbatim for AB2470 Reinstatement
I want to inform you that I have initiated an expedited grievance that will be reviewed. Additionally, I need to notify you that you can go directly to the Department of Managed Health Care to advise them that you have filed an expedited grievance with the Plan. The agency can be reached at 1-888-466-2219.