COB
Where in Iset do you go to update COB?
Eligibility, then other insurance
Where can you locate the preventive Care CDG?
What is Benefits and Coverage Advocacy
Are you required to get verbal permission to speak to a caller hen they are not calling for themselves or a minor dependent?
What do you need to get from the member before placing them on hold ?
What is there permission?
What do we need to obtain from the member to see if the specific DME equipment is covered?
What are HCPCS codes
Where in ISET can you locate a link to the Order of Benefits Decision Tree?
What is by clicking the "?" icon next to other insurances, under the eligibility tab.
Same-day surgery benefits, where the member is not admitted, are considered this.
Outpatient Surgery
What does PLOC and COC stand for?
What is proof of lost coverage and Certificate of Coverage
Besides getting permission, what else should you do before putting the member on hold ?
What is explain to member why they need to be placed on hold/silent hold and advise member how long they are expected to be on hold/silent hold.
This additional process must be completed, even if no provider search results were found or the desired service address of a provider is not found.
What is a CAA-Provider Status Letter?
In What SPA will you be able to locate the 7 rules of COB?
what is the Eligibility Advocacy
What is the difference between rehabilitative and habilitative benefits?
What is rehabilitative is learning skills that they once had and habilitative is learning skills they never had
If a member request to remove a password from their account, what would they need to do ?
What is submit the request in writing to the UnitedHealth Group Privacy Office/IRG (Individual Rights Group).
What is the 1st thing you need to do when performing an unshceduled call back?
What is call avoidence
What is any behavior where agent intentionally avoids customer interactions
How would we update COB with Medicate or Tricare?
What is Document and route
When quoting benefits for the member what else do we need to offer ?
What is to offer to check provider's network status.
What do we do if we receive a call from someone we know?
What is Transfer the Call to NPSR.
If a member places you on hold after the call has begun, how long should you offer to wait before disconnecting?
What is if hold time exceeds 2 consecutive minutes
What are the 3 categories for vaccines or immunizations?
what is Preventive, Therapeutic/Diagnostic & Excluded
Who would be primary if a dependent child (13) of separated parents has coverage under both plans and there is no court order in place with 50-50 custody?
What is the plan that has been in effect the longest would be primary
How is the RSV vaccine covered for a 67 year old?
What is it is preventive
In iset where can you click to get HIPAA help? and what does it give you?
HIPAA Disclosure HELP displays in the right corner of the screen in ISET. An agent can click the blue question mark to view the information to determine what can be disclosed to a caller.
In what SPA are you able to locate the abusive caller procedures?
What is Building Trust Through Advocacy, Escalation - Irate Caller, Using Abusive Language - May Need to Disconnect Call
Explain the difference between claim filing limit and grace periods in regards to financial accounts
Grace period is an extension of the plan year in which the member can incur new expenses, where the claim filing limit is how long they have to submit for reimbursements of eligible expenses