General
What is the timeframe given to answer an incoming call?
5 Seconds
What is the standard greeting?
Thank You for calling Meritain Health, My name is ........, May I have the Member's ID number please ?
You only use the benefit "Injectibles NC By Rx Card" when ?
The specialty pharmacy is billing directly for the drug .
Which tab shows a breakdown of services that are covered and if there are any frequencies ? (dental)
Eligible Dental Expenses
Claims take _____ business days to be processed .
30
Which place of service does not require precert?
Office
What is the closing script?
Is there anything else I can help you with today? Seeing there's nothing else , Thank You for calling Meritain Health , have a wonderful day .
Where do you quote surgical injection done in a doctor's office?
Office Surgery
For Dental , which tab tells you how much services are covered at by meritain ?
Dental Schedule of Benefits
True / False
Can you give the status of a claim in "S" Status?
NO
What does CPT stands for?
Current Procedural Terminology
When quoting "OON benefits" you should use the following scripting:
"Subject to a negotiated discount or other out of network pricing method"
Fill in the blank
____ does pricing , _____ Process claims
Aetna , Meritain
Which tab tells you about all services that are not covered ?
General Exclusions and Limitations
Where should you check first to see the claims mailing address ?
ID CARD
What does HCR stands for?
Healthcare Reform
What is the VERBAL CONFIRMATION GIVEN ?
"Are you involved in the person's Healthcare or responsible for Healthcare Payments"
What is the call type code for checking the status of precert ?
4B
For medical , which tab tells you how services are covered at by meritain .
Medical Schedule of Benefits
What is meritains payor id?
41124
When it is the EE or Broker , what should be beside their name?
Phi has to be beside of their name .
When the ivr populates the member id , how would you answer the call ?
Thank You for calling Meritain Health , My name is ........ , May I have your Name please ?
When searching for a preauth on file , and the provider don’t have a case # , what should you ask for?
Ask for the date that the precert was sent and the cpt code
Which tab tells you if the plan allows buy and bill ?
Prescription Drug Schedule of Benefits then you would go under specialty pharmacy program
If the claim is in P status for more than 30 days what should you do and what should you always check for ?
You should send an Urgent call referral to dept 343 (claims processing) . Always check to see if a call referral was sent first in the dot comments.