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
Use to send document via email and mail that have member's PHI.
Doculivery
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
We call it source of truth for overriding most of the process from solcen.
CA MAINFRAME
Cancelation codes we can reinstate
7, 8, 11, 13, 97
Standard Grievance resolution timeframe
Within 30 calendar days
This status of the bill indicated that a duplicate bill has been generated.
DUPBILL
Fine for every error.
$7500 per error
Refer to us, as our bible to check anthem process and system tools.
Knowledge Management
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
Use to validate, verify members information before releasing PHI.
Hipaa Tool
Bonus if one representative...
sings Bahay Kubo but all T is replaced by S
Example: Bahay Kubo kahis munsi ang halaman doon ay Sari-Sari
Difference between Administrative and Clinical Grievance.
Administrative: Dissatisfaction related to quality of service from provider / Anthem.
Clinical: Dissatisfaction with clinical care by provider.
What task in Solcen in which you will be able to check the member's premium?
Manage Enrollment and Billing Task
Spiel for expedited grievance
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.