Fundamentals
Our main system for C&S
what is CSP Facets
A case created when a baby is admitted into NICU
What is a NICU admit
what department are we in?
what is C&S provider services
where we go to socialize, post stories, promote fundraisers, share our story, like our "facebook"
What is Yammer
The first thing we do when the caller comes on the line
HIPPA Verify
ER admits require a CPT or HCPC code?
False
When someone intentionally misrepresents or conceals information to obtain something of Value. This can be something that benefits himself or another person
What is healthcare fraud?
we use this to check the members benefits
what is B360
where do we enter our exceptions (opw, training, coaching, project, etc)
what is IEX
The meaning for Tachycardia
the medical term for a heart rate over 100 beats a minute
This department creates BH cases
practices not consistent with accepted and sound medical, fiscal, or business practices. Such practices may directly or indirectly result in unnecessary costs to health care benefit program?
what is abuse?
Ms C is so awesome for creating this in order to use during my calls at all times
What is OneNOte?
Do we work for United healthcare or United healthgroup
What is United healthcare ?
5 digit code related to a specific procedure or service
What is a CPT code
"I show the CPT/HCPCS code(s) does not have prior authorization requirements. This does not guarantee coverage. Services are only payable if covered by the health plan and medically necessary. The provider website houses administrative manuals and reimbursement policies which can be used to determine if the services are covered by the health plan
." '
What is the no auth required script
If a provider calls regarding a claim that is NOT on file, remember to always check and provider the information located within _________
?
what is ECHO?
To determine who pays first, second or third I would refer to this tab in CSP facets
What is COB
we can go here to retrieve the number & call our providers back
What is Call history in VCC
standard form hospitals & facilities use to file claims for medical services
What is a UB-04
True or false:
In order to create a Maternity Case, Mother should be admitted "head in bed
true
"Would you be more likely or less likely to recommend UHC based on the call?"
what is Integrity Compassion Relationships Innovation Performance
to recognize an employee for the good work they do
what is BRAVO?