UHC 101
What does PHI stand for ?
Member went 63 days or more without part D coverage ?
what is LEP?
How long upon greeting/openings should script be given ?
all grievances have to be document in ?
If needing to send out an ID card what intent in Maestro will be used?
what is member materials?
AMOUNT OF MONEY YOU PAY FOR MEDICAL CARE BEFORE YOU INSURANCE PLAN COVERS COST
WHAT IS DEDUCTIBLE ?
LEP stands for
WHAT IS LATE ENROLLMENT PENALTY?
What is used to HIPAA Verify a member without IVR?
What is first& last name , DOB & permanent address?
When a member is in need of dire help regarding benefits or rx the grievance submitted would fall under...
What is Access to Care?
If member orders ID card twice in one month it is escalated and what is the turn around time frame?
what is 4-8 days not including printing, ordering, and laminating the ID card.
WHAT IS CAPITATION?
If a member is termed and wants to return to UHC that would be what intent ?
WHAT IS REINSTATEMENT?
A health care payment and delivery model that focuses on improving the outcome of patient and reducing the cost.
Type of member complaints...
WHAT ARE APPEALS, COVERAGE DETERMINATION, GRIEVANCE AND ORGANIZATION DETERMINATION?
Visit offered every 12 months for a physical assessment of the members due to not being able to visit their PCP or other number of issues?
MARY PAID OUT OF POCKET FOR HER DRS VISIT AND NEEDS TO BE REIMBURSED?
WHAT IS DIRECT MEMBER REIMBUREMENT?
If a member loses part B coverage they will be ?
what is disenrollment?
when a member calls in with a EOB and states they have received a bill what intent would be used?
what is Review Claim History intent?
WHEN A CLAIM IS DENIED A MEMBER HAS AN OPPORTUNITY TO ....
WHAT IS AN APPEAL?
Member is eligible to get OTC, pay utilities, fitness, dental, vision , hearing, use for Drs. and pharmacy, and rewards.
what is the UCard ?
How long does a member have to submit a DMR form?
WHAT IS 365 DAYS ?
If a member is inputted in the system as deceased and member is alive that is ...
what is Erroneous Death?
When a member is billed the remainder of the amount the insurance was billed...
When a member calls in with regards to a issue with the company it is considered ?
what is 30 applications ?