FUSE Task
The task used to request a Claims Summary
Request Copy of Correspondence
The member's address needs to be updated. Steps that need to be taken to update address.
Change address in FUSE
Fill out MCO form
The tab you will find the members Care and Case management information in FUSE
Member (360)
The name of the list that shows drugs covered under the plan.
Formulary
The benefit category X-ray's fall under
Diagnostic
The six acceptable forms of PHI
When members need their OnePass Code, what is the phone number the representative would use to conference call the member?
1-877-504-6830
The number of claims in Fuse at a time.
100
A member calls stating that they would like to use the same email for themselves and their dependents.
Online Member Account FAQs
The task used to add a newborn baby
Add Dependent
The name of the system other than FUSE we use to verify a members eligibility
MN'ITS
The turnaround time it takes to review a standard medical authorization request
14 calendar days
We can connect you to a pharmacy specialist to start the request over the phone with a representative from our pharmacy benefits manager.
Coverage Determination - first option always provided to members.
The benefit category mileage reimbursement falls under
Services that may be covered by other sources
A form found on the HUB to submit a variety of incidents.
Compliance/FWA/Privacy - Report and Incident
What is the name of the Rewards card that is provided to members when a voucher has been sent in for a reward?
Healthy Benefits + Visa Card
The FUSE task is used when a claim is denied due to other insurance, and the member states that they do not have other insurance.
Update COB
A MNCare member is calling about their 1095-B
1095 Forms - Tax Season
The task is used when a member wants to know if a medication is covered.
Check Formulary
Ways in which a Connect member can disenroll from UCare
Written, Fax, Disability Hub MN, Phone, Online Account
Members who have been placed on restriction by DHS due to excessive health services.
Restricted Recipients
The task in FUSE that you will find the question "Did the claim process correctly?"
Pharmacy Claim Inquiry
True or False - a mammogram could be considered preventive and/or diagnostic.
True
If a parent is not on file, what do you select in FUSE, and how is that parent authenticated?
Other parent - 3 PHIs
The name of the tab on UCare.org that you can direct a member to find the Rewards and Incentives available for their plan
Health & Wellness > Rewards and Incentives
If the date of service is more than 30 days and you are unable to find the claim, what must you do first before proceeding?
Contact CSS
Directs you to where and how to transfer callers based on their needs.
Call Transferring List
Additional knowledge articles for the Online Member Account task can be found where?
Pega (question mark on right hand side of FUSE)
Refer a Connect member to for any additional assistance
Disability Hub or MN Aging Pathways
Description of a Care Navigator
The name of the program we use to check if we received a pharmacy authorization
Navitus
The Benefit category compression stocking fall under
Medical Equipment and Supplies (DME)
The address and fax number to which a caller can send in POA paperwork to:
UCare Attn: Enrollment
P.O Box 52
Minneapolis, MN 55440-0052
612-676-6501 Attn: Enrollment
The phone number that a member would call to get information about some local food resources.
1-866-844-3663
A member calls stating that a bill was received and that it has not been 30 days from the appointment. In this scenario, this is what you would click in FUSE.
Claim not found
Connects with members to close gaps in care and promote the importance of preventive care.
Health Improvement Team
The task used to open CHIP Rewards
Create General Service Request
The place you refer a Medical Assistance member to call when they need a Certificate of Certifiable Coverage?
Minnesota Health Care Programs Member Help Desk at 651-431-2670 or 1-800-657-3739
A member calls and asks if they can access their Health Assessment through their online member account. How would you assist the member?
Members can access by going to:
Health and Wellness Tab and use the drop down arrow. The member will then go to an external site.
The member is calling for assistance to schedule a mental health or substance disorder appointment.
MSS Access - 1205
The benefit category Marital Counseling falls under
Mental Health
Members that have the below address:
Lot #
PO BOX 17370
St. Paul, MN 55117-0370
Safe at Home Program
What are the guidelines for a member to receive a car seat?
Elements of the required template when creating a provider follow-up.
- Patient name (if minor, include parent name on file with facility)
- Patient DOB (if minor, include parent DOB on file with facility)
- Patient's Phone # provider has on file: (verify the one in the account is correct. If not, update demographics as well.)
- Patient Address provider has on file: (if member has a temporary address, verify with a member which address was provided to the facility.)
- Has a member called UCare about this more than once?
- Has the member received more than one bill?
- Has member been sent to collections? (Tag case by using pound- #Collections)
- Is the caller different from member who received the bill (Ie. a parent calling for a child's visit?)
A member is calling about getting their medication early due to leaving on vacation for 30 days.
Refill Too Soon