Cars
Which screen can you view the AFV for a diagnosis when handling a Subrogation call?
Condition Screen
What type of coverage does the member need to have in order to enroll in Real Appeal?
Medical
What tab in HPDB to view deductible, out of pocket maximum and plan type?
Schedule of Benefits Tab
An overseas provider asks for an EFT number, where would you go in superuser to view check information
What tool do you use to update Other Insurance
OI Update Workflow Tool
What situations that will require subrogation review?
Occurred at a School the patiesnt does not attend, occurred on someone else's property or a business, Assault, work related, motor vehicle involved, sport related alcohol or drugs involved
Ineligible code 937 means the claim has been denied and UMR is requesting
Other Insurance Update
A member wants to know if she can get routine labs at no cost, what tab will you view to help this member?
Routine Care/ Real Appeal Tab- Diagnostics Subtab
What tool is used to see if a prior authorization is required
Prior Authorization Portal
When a member calls in to provide accident information, what tool in JIA would you access
Accident Detail Collection
Ineligible code 998 means the claim has been denied and UMR is requesting
Accident information
If a member asks “How do I submit a claim for reimbursement?” How do you respond?
Ask the member if they have access to UMR.com.
• If yes, explain how to file a claim on the member website.
• If no, explain how to submit manually via fax, email, or mail.
A member plans to have an MRI at the hospital he is working at. What tab will you view to help this member
Outpatient Tab
How do you determine if a check is a single or bulk payment
Advanced Claim- Check Number (Enter Check and Group number)
What tool would you open if you want to compare two claims that are possibly a duplicate
Claim Compare Tool
Which field on the Condition Screen will indicate if we are checking for accident details?
AFV
When a claim is denied with ineligible code 902, what does it mean?
Duplicate Claim
My son has one of developmental delay conditions and he is required to have at least 12 physical therapy sessions. Where would you look to help this member
Covered/ Excluded Services
User Browser
OI Update Yes
What does member have to do if they receive Subrogation letter 1325A
Member will need to fill out, sign and return the letter.
If a member is calling in for status of an appeal, where you should check this application for directions?
Onbase
A member wants to have IUDs removal and she wants to know how her plan will cover the procedure, which tab will you view to help this member?
Contraceptive Tab
Email Care Connect Template with detailed information
A provider does not receive their check and it has been more than 30 days since the payment is issued. What macro in Jia would you select?
Check Tracer - RA required