Review Trivia

HIPAA

100

The number of pieces of PHI needed to verify HIPAA

What is 3?

200

You can use one of these if the member is not able to provide one of the 3 primary forms of HIPAA identification (Member ID, DOB and First Last Name)?

Address, Phone Number, PCP Name

300

This is the form a member needs to fill out if they want someone to be able to receive information on their behalf

Limited Personal Representative

400

This is the form someone needs to fill out if they want someone to be able to make changes to their policy on their behalf

Legal Personal Representative

500

Caller must provide this in order for us to continue a call when there is a Confidential Communication flag

Password

Benefits

100

These are the three ways we are able to search for Benefits

Browse in Solution Central, NAEGS and Search

200

What a member pays each time they receive a healthcare service once they arrive at the location

Co-Pay

300

A member must pay off their _____ in order to begin the _____ phase of their coverage.

Deductible, Co-Insurance

400

This must be met for a member's plan to begin covering services at 100%

Out of Pocket Maximum

500

What we want to include in each quote to make sure members' are receiving the most out of their benefits

Vendors

Claims

100

The three pieces of information we need to search for a claim

DOS, Provider, Amount (can also accept Claim Number)

200

Two sections within the solution central task that we need to look at to research a claim

Claim Details/Line Details

300

This tells us why a claim was rejected

Reason Code

400

We submit one of these if there was an error in our processing of a claim

Claim Adjustment

500

A member can submit one of these if they feel their claim was denied unfairly.

Appeal

Call Handling

100

Our Greeting for Calls

"Thank you for calling your health guide with Horizon, my name is _____, how may I assist you today?"

200

Appropriate way to ask for telephone number

"May I have the best contact number to reach you in the future?" or "May I have your preferred contact number to reach you in the future?"

300

How you want to end each of your calls prior to the member hanging up

"Is there anything else I can assist you with today?"

400

What we want to say whenever someone new comes on the phone line during an active call

Verify HIPAA + advise they are on a recorded line

500

You should make _ attempts to warn a member about their inappropriate language prior to transferring to __

3, supervisor

Tasks

100

Soundra needs a new card for her doctors apppointment

Manage ID Cards

200

Moshe needs a list of dermatologists in his area

Provider

300

Cerrica needs proof that she has coverage for her college classes that begin this fall

Create Correspondence

400

Alvaro has another active health insurance plan that he wants to inform us of

Manage Other Insurance

500

Zachary is expecting a check and wants to know the current status of it

Cash