HIPAA
When should you check the participation status of a provider?
Prior to quoting any benefits
How would you know if a provider is eligible to be listed as a PCP?
Look for the Y indicator in the PCP Ind column
In Idaho, at what age will subscribers no longer have access to their dependents information via InTouch?
Minor dependents ages 15-17 will need to register under their own name
What is the first day of summer called?
The summer solstice
What is a CORA?
Court Ordered with Restricted Access - Only the person named on the confidential communication has access to the child's information.
The subscriber has no access to the dependents information.
Where would you check if a provider located in Ohio is in or out of network?
Aetna
What is different about adding a PCP to a Voyager plan?
If you look up a provider on a Voyager plan, the VOYOR, VOYID, VOYMT, VOYWA row will never have a Y for PCP indicator- but it is still ok to list it.
Yes, a confidential communication will block InTouch for all users, even subscribers.
What is the most famous summer blockbuster of all time?
Jaws, released in 1975
How long is verbal authorization to provide PHI good for?
Until the end of business that day.
How would you document a provider's participation status?
Subject: Provider Inquiry
Category: Participating/NNA OR Non-Par
New Tasks Notes: Provider ID, Provider Name, Network ID, Network Name, Address
Oregon policies require a PCP be assigned for members within 90 days of becoming active, what happens if no PCP is selected?
One will be auto assigned but claims will not be affected if no PCP is selected or member sees a different PCP than the one listed.
During initial registration for InTouch, members will be sent a PIN via email, how long is that PIN valid for?
22 Hours
How many pounds of watermelon do Americans consume annually?
On average, Americans consume 15 pounds of watermelon annually
How long is an authorization to use/disclose PHI good for?
2 years from the date it is signed.
What 2 questions are we legally required to ask when performing a provider directory search for a member?
Do you have a language preference for your provider?
Do you have a gender preference for your provider?
Are we able to list a provider outside of our service area as a PCP?
No, PCPs outside of our service area are not permitted.
What program would you use to verify if a member has registered as an InTouch user?
Utilize Web Application Manager (WAM)
What month is national ice cream month?
July is national ice cream month
What should you do if your call is regarding is a family member, friend, or acquaintance?
Advise you personally know the member and warm transfer the call to another CS rep for assistance.
Do we process claims based on NPI or TIN?
We process claims based on provider's TIN.
When updating a member's PCP, what should the effective date be listed as?
The new PCP effective date must be the first of the month
What steps could you take to troubleshoot a member being unable to log in to their InTouch account?
Verify the member is an InTouch user in WAM
Check to see if the account is locked
Verify the member is using the correct username (including spelling)
Summer is considered "peak hot dog season," how many hot dogs do Americans consume between Memorial Day and Labor Day?
Americans consume an estimated 7 billion hot dogs during this time period