Intake
EE has to abruptly leave the phone call and you have not completed the intake process or the phone line disconnects and you are unable to get the EE back on the phone.
What is putting a claim on hold?
What two groups must you verify the HR contact in SI?
What is State of Oregon and State of GA?
True/False - It's okay to provide the EE with their SSN.
What is False.
Following your schedule and placing your phone in the right Aux state.
What is Adherence?
Contains information that the employer provides us to assist in setting up claims for the member.
What is BMV (Benefit Member View)?
Verify Admin/Tax Units, Check all necessary fields are completed, Confirm HR contact, Generate activities, Approve the EE Statement
What are after intake tasks?
What two tabs must the HR contact be on in CIS?
What is the Claimant and Employer tab?
If someone is calling on behalf of the EE and doesn't know their DOB, you should?
What is use a generic DOB 11/11/1902?
96% is the minimum expectation
What is PCS?
In order to determine what type of claim you should set up for the EE, you will need to review the current products listed under_______?
What is Benefit Information?
Check Sales Office and ASO Type populated
What is the Additional Data tab?
What tab must you go to and check off the HR Contact has been verified for two particular groups?
What is the Follow-up tab?
True/False - If the address/phone number/DOB/SSN differ what came through on the feed from BMV, it's okay to change this information if you are not speaking with the EE.
What is False?
What is Average Handling Time?
So policies that have NY employees only offer "BST" instead of "ST". What does BST stand for?
What is Buy up STD?
It is important to save a copy of the intake once a claim has been completed.
What is commit to repository?
If the HR contact is not listed in CIS the _____is not sent out.
What is Employer Statement?
True/False - Anyone can file a claim on behalf of an EE?
What is True?
Currently, the team is at 88% on this metric.
What is Quality?
If a telephonic group calls to initiate a claim but the feed does not display any claimant results, you should check what?
What is Special Instructions? Some groups have telephonic services but do not provide a data feed.
EE calls us to advise their LDW date has changed, you have documented CIS, adjusted the LDW and FDA on the claimant tab, what's next?
What is Regenerating Dates?
HR contact should populate from BMV in most cases, but if it doesn't you should check _________.
What is Special Instructions?
True or False - You should document the info someone is providing on behalf of the EE if is it different than what we have?
What is True?
What is 778? (12:58)
If an EE was seen in the hospital or the ER, confirm the dates they were seen and document in the ____ section.
What is the Comments section?