How Much Time Do I Have?
How much time do you have after case assignment to submit your first RFI?
What is 2 business Days?
This doctor has appeared on Oprah, thinks breakfast is a joke, you should eat brunch instead, and is currently serving as an administrator for CMS.
Who is Dr. Oz?
Triage
Who is Aqualia Bryant / Natasha Mitchell?
Manager
Drew – up to $5000
T or F – A balance billing case must have a claim on file
False
Documentation on a case needs to occur every _ days.
What is 3 business?
Instructor of spin classes – Manager of Dental Consultants for Delta Dental
Who is Dr. Green?
CMS (CDPHP)
Who is Christina Dickson?
Director
Brittany Lione – 5k to 25k
What is the name that appears as the sender when sending responses to Kaiser?
Leslie Camal
How many days do we have to complete the refund once a case is completed?
What is 14 Days?
This doctor was a child prodigy
Who is Dr. Doogie Howser?
DeltaCare
Who is Jennifer Hoffman/Chaitra Gowda?
VP/GVP
Alicia Gray - 26k to 100k
What is the queue for manager approvals?
G&A WROF Approval
The turnaround timeframe response to the executive complaint or inquiry must be communicated to the enrollee/member within __ days from the date the Plan received the complaint.
10 calendar days
his doctor also appeared on Oprah, and if you have ever seen this man on this show, you know that whoever is the guest on the show is about to have an intervention.
Who is Dr. Phil?
Quality of Care/Access to Care FFS
Who is Katie Nulty / Jameson Horacek?
SVP/EVP
Jen Macgilvray - 100k to 150k
I have a case with a billing dispute and a QOC component. Should my case be an appeal or grievance?
Grievance
How much time do you have to complete an expedited appeal?
What is 72 hours?
“You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose.”
Who is Dr. Seuss?
Appeals FFS
Who is Simone Jester/ Sheila Gonzalez?
CFO/President/CEO
Sarah Chevarria - anything over 150k
I entered an extension in PEGA. How many days does PEGA show once the extension is added?
30 days after extension is added – THIS DOES NOT MEAN YOU HAVE 30 EXTRA DAYS!!