Benefits
What does "not MCO liability" mean?
We do not cover/Send to state
Which system do we use to view claims?
HRP
CRM(Salesforce)
SDS
What are the names of the Grievances we do?
Billing
ID Card
Provider
Pharmacy
What candy is known as "the candy that melts in your mouth, not in your hand"?
M&M's
Is a pumpkin a fruit or a vegetable?
Vegetable
What do we use the fee schedule for?
To verify if the cpt is billable
Medstar's Claims Numbers start with what at the beginning of the claim number?
The Year Claim was submitted.
Where can we find Grievnace Templates
Genesys
&
Sharepoint
Which candy bar is named after a famous horse owned by the Mars family?
Snickers
What is a group of witches called?
Coven
For both MD and DC , what is needed for out of network services?
Prior Authorization
What system is our source of truth for claims?
HRP
When do we create an ID Card Grievance
Member Never Received one
What candy comes in a roll and is known for its chalky texture and fruity flavors?
Smarties
What is the number one-grossing Halloween movie of all time?
Annabelle (2014)
is Acupuncture for members >21 years old for both DC and MD covered?
Not covered benefit
When a claim denial does not give a clear answer, where do we look for more information?
Header Tab
Audit Log
Line Number
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
What candy was originally called "Chicken Feed"?
Candy Corn
In which Shakespeare play do the witches say "double, double toil and trouble"?
Macbeth
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.
What is the clearing house number on a claim used for?
To Pull up Claim In SDS
Member calls to file a grievance on a provider, what should be in our resolution?
Offer member a list of new providers to see!!
Which candy was originally called "Opal Fruits" in the UK?
Starburst
In which country did Halloween originate?
Republic of Ireland