True/False
You never have to use Mentor!
FALSE! you should use mentor every call you take!
You are needing to transfer a member to the member department, what class/intent do you document in QuickStart?
Classification- Other/Miscellaneous
Intent- Member Call Transfer
What is Mentor used for?
Mentor gives us the up-to-date steps and processes to handle our calls correctly! Mentor is our BFF for EVERY call!
What mentor document is needed for HIPAA?
HIPAA Overview CCC Provider!
What do you aux in genesys for lunch?
LOG OFF
We can assist with handling PCP changes!
FALSE! We can only speak to providers about the network status, or who is currently listed on file. For PCP changes, member would have to call the member department!
Provider is needing to become in network with Humana, what class/intent will you document in QuickStart?
Classification- Provider
Intent- Request to Join Network
What is PAAG?
Provider at a Glance shows us providers credentialing information as well as contract updates!
What are two types of authentication?
Automated Line, or CCC Advocate!
What is WFO used for?
Schedule / Break information
Physican Finder is used to verify member eligibility!
FALSE! Physican finder is used to verify if a provider is in network/accepting new patients!
Provider is needing help with Availity navigation, what class/intent will you document in QuickStart?
Classification- Web
Intent- Availity
What do we use EMME for?
To send letters as well as check letters that have already been sent!
What are 5 examples of PHI?
Zip Code, DOB, PCP on file, City, Phone Number
If your schedule is 9-5:30, what time would you aux ON QUE?
9am on the dot
NPI shows us multiple facilities on file!
FALSE! NPI is for the specific provider, TAX ID is for facilities/multiple locations!
What classification/intent would you document for a provider needing to verify the status of an appeal?
Classification- G&A
Intent- Status
Which system has more up to date LIVE information? CRM or CI?
CI! CI is a LIVE system, where CRM takes 24-78hours to show updated information!
What is the copay for Pharmacy per the benefit grid?
5% of household income!
How often should you approve your times in TCP?
Everyday!
Medicaid only covers in network services/providers, only exception is if we have a waiver approved on file!
TRUE!
Provider is needing a reprint of the Explanation of Remittance, what class/intent will you use?
Classification- Reprint Request
Intent- EOR
Why do we use the MHI screen in CAS?
To view 1 specific claim processed on a member!
How many visits per YEAR can a member have physical therapy services?
*hint- its on the benefit grid, do your drop-down benefit name to find the correct info!
15 treatment visits per calander year!
Once you authenticate and create your interaction, what's the next step for your call?
Input the correct class/intent to show you the correct mentor document needed!