Benefits
Claims
Grievances
Candy
Halloween Time!!
100

What does "not MCO liability" mean?

We do not cover/Send to state

100

Which system do we use to view claims?

HRP
CRM(Salesforce)
SDS

100

What are the names of the Grievances we do?

Billing
ID Card
Provider
Pharmacy

100

What candy is known as "the candy that melts in your mouth, not in your hand"?

M&M's

100

Is a pumpkin a fruit or a vegetable?

Vegetable 

200

What do we use the fee schedule for?

To verify if the cpt is billable

200

Medstar's Claims Numbers start with what at the beginning of the claim number?

The Year Claim was submitted.

200

Where can we find Grievnace Templates

Genesys
&
Sharepoint

200

Which candy bar is named after a famous horse owned by the Mars family?

Snickers

200

What is a group of witches called?

Coven

300

For both MD and DC , what is needed for out of network services?

Prior Authorization 

300

What system is our source of truth for claims?

HRP

300

When do we create an ID Card Grievance

Member Never Received one

300

What candy comes in a roll and is known for its chalky texture and fruity flavors?

Smarties

300

What is the number one-grossing Halloween movie of all time?

Annabelle (2014)

400

is Acupuncture for members >21 years old for both DC and MD covered?

Not covered benefit

400

When a claim denial does not give a clear answer, where do we look for more information?

Header Tab
Audit Log
Line Number

400

What is the most important thing to add to a grievance about a member that has an issue with a provider, besides all the details of their complaint?

Provider Details:
Name
Address
Phone Number

400

What candy was originally called "Chicken Feed"?

Candy Corn

400

In which Shakespeare play do the witches say "double, double toil and trouble"?

Macbeth

500

Is there a difference between MD dme services and DC dme services for what requires auth?

no, for both, Prior auth required for claims billed >$1000 or rental equipment over 90 days.

500

What is the clearing house number on a claim used for?

To Pull up Claim In SDS

500

Member calls to file a grievance on a provider, what should be in our resolution? 

Offer member a list of new providers to see!!

500

Which candy was originally called "Opal Fruits" in the UK?

Starburst

500

In which country did Halloween originate?

Republic of Ireland

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