Insurance Basics
What do we do if a member states they want to terminate a dependent on their policy?
Contact their respective Marketplace/Employer OR direct them to fill out the respective state's individual change form.
How do you search a provider in Facets?
Transfer > Practitioner > Open Customer > Search > Name, Address, EIN
This British Prime Minister gave a speech in 1940 known for the phrase “We shall fight on the beaches.”
Michael Caine
How often can a preventive colonoscopy be billed?
Once every 5 years for ages 45-75
What is the 48/96 rule?
48 hours for vaginal delivery, and 96 hours for C-Section
Anything exceeding this time will require a pre-auth from the provider
What are the names of the State Marketplaces?
FFM, YHI, SSHIX, C4HCO
What information is needed to verify panel status?
Name, Address, sometimes NPI (as a backup)
Known as the father of the computer, he conceptualized the first mechanical computer in the early 19th century.
Steve Jobs?
Name the 6 IUDs that are covered.
Mirena, Copper T, Skyla, Liletta, Kyleena, Paragard
What does the global fee include?
Prenatal, urinalysis, labor/delivery and one postpartum visit
What is an APTC?
Annual Premium Tax Credit (Premium credit)
What is the most common NWPR Prefix?
N001
This 1941 American drama, directed by Orson Welles, is often cited as the greatest film ever made.
Spice World
How can we check to see if a provider can bill a specific DX and if the DX it preventive?
Preventive Care and Screening Guidelines [#06] on the provider section of selecthealth.org
What is Healthy Beginnings?
Healthy beginnings is a program available as a free service to expecting mothers who are members of any Select Health plan. The goal of this program is to increase the potential for healthy pregnancies and full-term births and free pregnancy education materials are available
Can I get APTC or CSR with a INDV Direct Policy?
No, APTC and CSR are available for all SH Service Area Marketplace plans only
Who would we transfer the caller to if needing to find an INN Provider?
Advocates
This composer’s works include “The Magic Flute” and “The Marriage of Figaro.”
Miley Cyrus
Does a provider have to be INN for preventive bens?
Yes
What benefits are not included in the Global Fee and how are what benefit are they covered under?
Ultrasounds and Lab Work - Covered under the Minor Dx benefits.
Name 3 types of Qualifying Life Events (QLEs) that may grant an SEP?
Family additions or changes, Loss of healthcare coverage, Move or change in permanent address, Changes in income
What counts as preservice? Name 3
Benefits, code check, ID card request, Preauth
This Russian author wrote “War and Peace.”
J.K. Rowling or something
What is the frequency of an annual physical?
Once every 275 days with no grace period
If a mother had twins, can she get a second Breast Pump for her second child covered under the preventive benefit?
No - Breast Pumps are only covered at 100% once per pregnancy/adoption