Benefits
What benefit do you provide when the caller wants hearing aid benefits and the member is on a premier plan and the provider is in-network?
What is the ded/ oop
What on a claim confirms why it was processed that way?
What is a reason code?
Member calls for benefits for their doctors office visit.. what would be the concierge thing to do for the member?
What is verifying network status of provider and educating the member of their network status?
What vendor can assist members and their eligible dependents with finding and navigation support resources such as community support groups and transportation?
What is Help Now?
what resource would you use to verify age restrictions for services?
PPACA grid
What is the limitation for nutritional counseling for children?
What is none?
You check this system for out of state requests?
What is blue2?
If a members claim denied due to premiums, what would be an additional concierge thing to do when routing claims in question over for review?
What is seeing if any other claims that have denied for premiums as well and attaching to case to be reviewed?
Who is our vendor who handles company paid life insurance?
What is Prudential?
What system would be used to verify an In-state providers network status outside of the Embold provider guide?
What is Provweb?
This plan has a responsibility until the ded is met for Doctor on Demand?
What is the saver plan?
What group of people do we refer In-state providers to when they need assistance with resolving claims issues, help them file for reimbursement, answer billing and coding questions, and help in any way they can?
What is Network Development Representatives?
If provider calls to verify eligibility and wants something in writing, what can we do?
What is offering to send a verification letter?
Second opinion services are administered by?
What is Included Health?
What search do you use to find Authorization letters? (approval, denials, additional info needed)
What is Affinite Outbound content search?
What applies for a member on the Savers plan for Omada for Joint and Muscle Health?
What is no cost to the member after they meet their deductible?
What department do we route claims to if denied due to premiums?
What is Walmart Membership Adjustments?
What is a resource we should be educating members on when they call asking for pricing?
What is the cost estimator tool on blueprint portal?
What vendor handles HSA?
Who is HealthEquity?
What search in P8 would you use to locate Remittance advise for In-state providers if Availity is down?
What is check image and/ or Provider Communication Document?
If the oop is met, does the ded have to be met as well?
What is no?
What's a common service that denies on claims just for it being billed as a screening?
What is a psa (prostate specific antigen)?
If a member had medical questions/ concerns, who should we get them over to?
Who is case management?
Who are the new Centers of Excellence Vendors?
Who is Carrum Health & Consociate Health?
Who can we reach out to when members are having issues regarding the blueprint portal that we can't resolve?
Who is Digital Solutions?