Policy Implementation
Documentation to initiate a plan/policy change.
What is a Route Sheet?
Claim action by Analyst prior to sending to Case Management for handling.
What is entering and pending a claim?
Provincial Plan Replacement Coverage.
What is Benefit 19?
Assignment of Benefits, Member Signature, Claim Form and/or Invoice, Services, Amounts, Dates of Service, Provider Information, Diagnosis (if applicable).
What is required to pay Provider Claim?
PPN is the acronym for which department.
What is Preferred Provider Network?
Benefit 25, 26, 27 carrier and coverage.
What is Allstate Critical Illness?
Action for Claim that is over Carrier Threshold, specific Diagnosis, High Dollar, Case Number or certain services.
What is send to Case Management for handling?
Top Five Cowan Clients.
Who are UHIP, SACB, CignaLinks, SAWP, Allstate?
System tool capable of processing high volume of claims by loading provider spreadsheets.
What is CLASS Bulk File Tool?
A provider removed from list of eligible providers due to fraudulent behavior, resulting in claims no longer being processed or paid.
What is a delisted provider?
Six digit number to link agency and policy for enrolment.
What is Occupation Code?
The process of returning an insured member or their remains to their Home Country.
What is Repatriation?
Grand-daughter of the founder of Cowan.
Who is Maureen Cowan?
Pharmacy Identifier when processing a manual drug in claim ESI from the Province of Alberta.
What is ABCDN00000?
Third Party Requests, Medical Records Fees, Medical Notes, and other Administrative Fees.
What are Not Covered Benefits?
System that is coded to allow members to use Direct Billing.
What is ESC/ESI?
System used by Case Management Team.
What is COLO?
Monthly TPA meeting hosted by Vice-President.
What is Kelly's Happy Hour?
Claims reimbursement based on CRA guidelines.
What are Health Care Spending Account Claims?
Claims sent in Laserfiche to the Provider Queue.
What is to add a Provider ID?
Supporting Documentation needed to build or apply plan changes to a group.
What is a BAAG and/or SOB?
Reviews Medical Records and documetation to support high dollar or complex claims.
Who is Dr. Sylvie Hudon?
Valuing the qualities, skills and positive attributes of the people we work with, and appreciating what they bring to the table.
What is Respect?
3 to 5 Business days.
The Salesforce Queue to request a Stop Payment.
What is the Finance Queue?