HPDB
Where would you find the benefits for acupuncture?
Covered/Excluded Tab
Where can you find claim ineligible codes?
Ineligible codes P&P
Tickler
Where can you find if someone can speak for someone else
Authorized Representative
What kind of transfer should all member calls be?
Warm Transfer
Where do you find if plan has opted into model to take provider calls as well as member calls?
Advocacy Solutions Tab
How can you tell if a claim was adjusted?
Red "YES" or the reversal number 14
How many lines can I add before getting an error in CT?
10
How can you pull Plan Advisor Dashboard from CPS?
Plan Advisor Refresh
Where can you find if plan is calendar year or plan year?
Schedule of Benefits tab
How can you pull a claim without a member ID?
Enter the ccn into the claim control box on home screen
Write a Calltrak for the following:
Provider Jill is calling from Dr. Smith's office she is calling about Outpatient surgery and they are In Network with UHC Choice Plus. You quoted the surgery would apply towards the deductible with 80% coverage after. Deductible in network is $2000 individual/$4000 family, out of pocket is $6000 individual/$8000 family. There is no Prior Authorization needed.
Jill/Dr. Smith office/vphi/outpat surg
inn w/0L outpat surg ded applies/80% cov/inn ded $2000 per person/$4000 fam/inn oop max $6000 per person/$8000 fam/no PA rqr
Where do you find Accums?
Level of Benefits
When you get a call regarding DME what P&P should be used on those calls?
DME Reference List
What tab would you find if Autism is covered?
MHSA
Where do you find network repricing?
Webclaims image
Can you add info into a closed tickler?
No
Where do you view medical necessity reviews?
FYAA
Where can you find phone numbers to transfer to?
CFR Reference Sheet
Where will you find COBRA vendor?
General > Contacts
$25,000
What is the site specific TPX ID for Syracuse Plan Advisors?
SYPA
If a member is showing an effective date of 01.01.21 but states they had covered in 2020. What can I do to verify
Change the begin service date to 01/01/20 on the home screen of CPS. Can also search their name in Superuser member lookup.
What is the difference between Telemedicine and Telehealth?
Telemedicine is through individual vendors such as Teladoc. Telehealth is through the member's own provider using that provider's platform.