MACEES
WHAT CATEGORY DO YOU SELECT WHEN SENDING A ROUTE FOR ELIGIBILITY DISCREPANCY?
CSP-GENERAL REQUEST FORM
WHAT IS AN APPEAL?
RECONSIDERING(FIGHTING) AN INITIAL DECISION
WHAT IS THE DIFFERENCE BETWEEN AN EOB AND A BILL?
WHAT SYSTEM DO YOU USE TO CHECK FOR GAPS IN CARE?
COMMUNITY CARE
HOW DO YOU SIGN INTO RX CLAIMS?
WHEN YOU SIGN ON PRESS 1,1,2
WHAT DAYS ARE YOU ALLOWED TO SEND MACEES COMMITMENTS?
MON-FRI FOR ANY MACEES ROUTE EXCEPT FOR PROVIDER SEARCH COMMITMENTS ON FRIDAY
WHAT IS A GRIEVANCE?
WHEN A MEMBER WANTS TO COMPLAIN ABOUT A SERVICE
WHAT DO YOU ASK FROM A MEMBER WHEN THEY CALL SAYING THEY HAVE RECEIVED A BILL?
WHAT SYSTEM IS USED TO PROVIDE MEMBERS EXTRA RESOURCES? EX: SHELTER, FOOD BANKS ETC.
HEALTHIFY
WHAT ARE THE CO-PAYS FOR EACH STATE?
ARIZONA:DEPENDS ON PLAN
LOUISIANA: .50-3.00$
WASHINGTON: NO CO-PAYS
WHAT IS THE TAT FOR A COORDINATION OF BENEFITS ROUTE?
3-5 BUSINESS DAYS
WHAT SYSTEM DO YOU USE TO CHECK STATUS OF APPEAL OR GRIEVANCE?
ETS
WHAT 3 CATEGORIES MATCH WHEN THE CLAIM IS PAID FOR?
ALLOWED, CONS ALLOWED, BENEFIT
WHAT SYSTEM DO YOU USE TO CHECK FOR PRIOR AUTHORIZATIONS?
ICUE
WHAT ARE THE GROUP, BIN & PCN FOR LA?
GROUP :ACULA
BIN: 610494
PCN:9999
LIST OF PROVIDERS YOU CALLED, REASON FOR NOT TAKING MEMBER IN, IF THEY WANT APPT SCHEDULED
WHAT DO YOU DO IF A MEMBER HAS A GRIEVANCE TOWARDS LOGISTICARE(TRANSPORTATION)?
WARM TRANSFER TO LOGISTICARE
WHAT 2 WAYS DO YOU CHECK FOR CLAIMS?
MEDICAL CLAIM TAB ON FACETS & TRANSFERS>CLAIM INQUIRY>OPEN CUSTOMER/MEDICAL
WHEN LOOKING FOR PROVIDERS WHAT 2 THINGS DO YOU ASK?
IF THEY TAKE THE INSURANCE AND IF THEY ARE ACCEPTING NEW MEDICAID PATIENTS.
WHAT DO YOU DO AFTER YOU REMOVE A FLAG ON RX CLAIMS?
REACH OUT TO PHARMACY AND LET THEM KNOW TO PLEASE RE SUBMIT THE CLAIM
HOW DO YOU SAVE A MACEES ROUTE?
FLOPPY DISK, CHECK MARK, F4
WHAT CAN A MEMBER DO WHEN AN APPEAL IS UPHELD?
STATE FAIR HEARING
WHAT DO YOU DO WHEN MEMBER IS RECEIVING A CLAIM THAT IS NOT REFLECTED ON FILE?
CALL PROVIDER, MAKE SURE THEY HAVE CORRECT INS INFO ON FILE AND ASK THEM TO RE SEND THE CLAIM
WHAT IS THE NAME OF THE UHC PROJECT MANAGER?
DANIEL MARTINEZ
WHY DOES A MEMBER HAVE A FLAG ON RX CLAIMS?