Kelsey Seybold

Basics

100

Where is Kelsey-Seybold Clinic located?

• Houston, TX area. Most Kelsey-Seybold members will be located here.

200

What is value-based care?

• Value-based care (also known as delegation) is an arrangement in which UnitedHealthcare partners with a contracting medical group (such as Kelsey-Seybold) to help coordinate and manage members’ care.

300

There are two tabs in Maestro to check Member's Plan Information, which are they?

Plan and PMG Tab

Referrals

100

TRUE OR FALSE
If a member calls about referral information, I should transfer the call to Kelsey Seybold Support Department

True

200

When should I be able to see Kelsey Seybold Referrals in Maestro? 

Never

300

TRUE OR FALSE
If member is looking for a Specialist but has not referrals, I should help this member instead of transferring to Kelsey Seybold Customer Support.

False

Claims

100

TRUE OR FALSE
I am able to view claims directly in Maestro but Only if these has been already processed by UHC.

False - Kelsey Seybold Claims are not being processed by UHC but directly from the delegated entity (Kelsey Seybold)

200

TRUE OR FALSE
Claims are processed by Kelsey Seybold but paid by UHC directly

False - Claims are paid and processed by Kelsey Seybold

300

What is the name of the Intent in Maestro to locate referrals once processed by Kelsey Seybold?

Review Medical Claim History - Intent

Prior Authorization

100

Who is the one who start the PA process when a Medical Treatment or OON benefit is required?

Member

PCP

Delegated Partner

Member's PCP

200

What is the TAT for a PA in Texas? 

Three Calendar Days

300

TRUE OR FALSE
Members may see PAs on MyKelseyOnline before UHC sees them.

True

Super Bonus

400

Explain in your OWN words TOC

30-day transition period for new members to see out-of-network providers.

500

Explain with your OWN words COC

For current members when a treating provider leaves the network.