C-KIT Job Name
(CSRs) should reference this knowledge when:
A customer calls requesting to update (HIPAA) consent.
An individual calls requesting to be added to a customer's account as a personal representative in order to make decisions on the customer's behalf.
A customer wishes to remove a personal representative from their account in QNXT.
What is Add and Terminate Personal Representatives?
This plan offers prescription drug coverage, which subsidizes the costs of prescription drugs for enrollees. A stand-alone plan, covering only prescription drugs.
What is Prescription Drug Plan (PDP)?
Any doctor who is contracted and credentialed with Cigna-HealthSpring to provide initial and ongoing primary care to a member in order to maintain continuity of patient care.
What is Primary Care Physician or Primary Care Provider (PCP)?
Customer Service Representatives and others should reference this knowledge for the contracted vendors who can perform a 360 exam for one of our customers.
What is 360 Exam Vendors?
An enterprise application system that encompasses functional areas like claims, customer service, provider services, medical management, finance, and accounts receivable for businesses managing single or multiple healthcare products.
What is QNXT?
CSRs and all others should reference this knowledge when they have questions regarding the standard and special materials request process.
What is Process a Materials Request Call?
This plan is for customers with a range of special health care needs, including chronic illness.
What is a Special Needs Plan (SNP)?
CSR's will use this directory to search for a doctor
What is Online Provider Directory?
CSR's should use this vendor when handling calls from Non-English speaking Customers.
What is CQ Fluency?
The Customer Service team should used this system or tool to see if an authorization is required based on procedure code.
What is System of Healthspring Reference and Prior Authorization (SHRPA)?
Customer Service Representatives should reference this knowledge when needing to verify a customer's Hospice status.
What is verify a Customer's Hospice Status in QNXT and MARx
This plan facilitate the offering of prescription drug plans (PDP) and Medicare Advantage prescription drug plans (MAPD) to employer/union group health plan sponsors.
What is Employer Group Waiver Plans (EGWP)?
This is a tightly focused team of medical professionals within our network. Providers in this network work together to coordinate their patients' care. It is a legal entity so it shares the financial risks and benefits with CHS.
What is IPA (Independent Physician Association)?
Upon release from the hospital, the attending provider or the customer's care coordinator will order from the vendor, GA Foods.
What is the Post-Hospital Meal Benefit?
A system or tool that provides the CSR's their schedule for the day with includes breaks and lunches.
What is NICE IEX?
(CSR's) and others should reference this knowledge when they receive calls from customers who plan to move either permanently or temporarily.
What is Process a Call for Temporary and Permanent Customer Address Changes?
This plans do NOT require referrals. Southern Mississippi, North Carolina, and Tennessee are offering this plan.
Customers enrolled into this plan can contact a Specialist directly for services, including services that previously had referrals in 2018.
What is Direct plan is a plan with no referrals?
This network is formed around a hospital and include PCPs, facilities and specialists. PCPs This network is not a formal legal entity and it is formed by the health plan. This network shares the financial benefits without the risks.
What is POD (Physician Organization Delivery System?
Enables customers to conveniently visit a behavioral health provider via audio or video
What is Telehealth Behavioral Health Benefit?
This tool was designed to assist CSRs with identifying OD, CD, Appeals, and Grievances, and to assist in locating processes in C-KIT by including the Document IDs within the tool. The tool will generate a summary of the call. The CSR will Click Summarize, select Copy Summary, and paste it in the Notes field in QNXT.
What Customer Service Decision Tool 2.0?
(CSRs) should reference this knowledge when s customer wishes to cancel his/her Cigna-HealthSpring prior to becoming effective with new plan.
What is Process a Request to Cancel Enrollment Before Start Date?
This plan requires referrals. Arizona, Pennsylvania, and Tennessee are offering this plan for 2019. Cost savings are passed onto customers, offering a more affordable plan.
What is Alliance is a Provider Specific Network plan?
This is a 10-digit identifier required on all HIPAA standard electronic transactions for provider's.
What is National Provider Identifier (NPI)?
Upon release from the hospital, the attending provider or the customer's care coordinator will order from the vendor, GA Foods.
What is the Post-Hospital Meal Benefit?
Provides the framework necessary for claims to adjudicate properly and quickly against a defined benefit plan, providing a quick turnaround of information not only to the pharmacy, but to the benefit manager as well.
What is Optum RxClaim?