Thinking Question's
For United healthcare do we have 365-day timely filing period that we must follow for providers calls only?
yes we do
What client's do we use the member bb inquiry issue type for?
UHC, UHC EPDP, UMR, Oxford, Oxford EPDP, Golden Rule Inc., Rocky Mountain, or Student Resources
How long can a Stand on claim stay in your que?
How long does it take for a provider to receive access to the portal?
Up to a week
if claim is closed as successful negotiation, can you reopen for review again?
no because our handling is complete on our end
For all Aetna calls is the 365 days rule waived?
yes it is
If there is an already opened Member BB request Issue type and the member is calling in stating, they haven't received the email with the with the link, what would you do?
You would ask them to check their spam to see if it went there.
If it didn't go to spam, then just resend the link to them again. Add an action Request BB to the already opened issue type
For Aetna provider calls only if they don't accept offer what closure will you use?
inquiry resolve
provider is stating that they do not want they claims sent to us. Can we stop it on our end? Or what can we say to them?
No
Advise the caller you do apologize but the claims are sent to us by the client/insurance. You will need to contact the client and speak with their internal department to discuss having your claims not sent to us for pricing.
What status should be in your queues c, b, z?
c only
For NJ surprise bill if they don't accept the offer what appeal options will you give the provider. what closure do you use?
Email: NJ_outofNetwork@uhc.com
Certified mail via the address on the back on member id card
Web from https://www.uhcprovider.com
Inquiry resolve
If you get a call from the patient advocate on behalf of the member which issue type, do you open?
Member Inquiry or Member BB Request
Member BB Request
For UHC EPDP and Oxford EPDP what closure will use if the provider doesn't accept the offer?
Max allowed
If the provider states they do not want a callback, or refusing the discount or do not want to Negotiate, we respond:
“I understand you are frustrated, but I am escalating for a callback to one of our specialist who can provide you with more details around the pricing and assist you with your questions.”
if there is no savings- lost savings on the claim, can you reopen the claim up again for review?
No, we can't we will refer caller to the client for any additional questions?
How long can you place a caller on hold?
2 minutes long
This is for the UHC & affiliates only
If the client is calling in on behalf of the member with them on the line, will you open a member bb request? Or will you open a MI?
Member inquiry (MI)
If the provider accepts the DIS Allowed amount, will they get additional payment?
NO
If the provider calls in and state that they login is not working on the portal, what can you do or say?
apologize to the provider/ show empathy
advise them you can send an email to Discustomerservice@dataisight.com and a ticket will be opened through our support team?
What is the time frame that the TIN has to be in for us to still consider it as Municipal Ambulance?
12 months
If a claim is closed as successful negotiation do, we send the claim back to the client, or do we just send an update?
The entire claim is sent back because we have to send the repricing sheet since there was a change the pricing.
Do we use the Member bb issue type for UHC & affiliates if the Member paid the claim up front and they are calling in on there on behalf?
Yes, we do, and we have them send in a copy of the receipt
How long can you hold a Meritain claim in your queues if the provider states that they are willing to accept the offer, but you get no response from the provider?
1 business day and then you have to auto assign
If a provider calls and would like to know how much we allow for a service before they actually
See the patient.
We are not able to provide any information upfront before receiving the claim from the
Insurance. Each claim is handled on a claim by claims basis, and all claims are not routed to us.
For UHC member inquiry for a Municipal ambulance claim how would you close it?
BB May occur