Call Process
Jennifer Bello
Support Service Greeting
What is Good morning/Good afternoon, thank you for calling Support Services, my name is (agent name), how can I assist you today?”
True or False: We are not to document Misrouted Calls
What is False, even though a call is misrouted we are still to document the call
True or False: We do not provide benefits for podiatry
False we service HUMANA CPN PODIATRY
The standard mileage we are able to look for in network providers
What is 50-60 miles
Days it takes for a POD to be reviewed
What is 7-14 business days
Closing Statement
What is “Have I resolved the reason for your call today?”
After expiring an authorization we need to document and include
what is Location ID, Rep name last name initial and Authorization ID
Name of Health plan we do CPN for
HUMANA
Humana called advising that they spoke with Visionworks regarding a member that returned there eyewear in 30 days from receiving it
What is a reinstatement
Providers or Members asking if Cataracts or a Certain CPT code is covered for medical procedures
What is a PA - PRIOR AUTHORIZATION needs to be submitted to determine coverage
Information gather from Friend or Family of member
What is First name & Last name , relationship with member
Attorney of member calls to get medical records...we need to make sure we document
First and last name, relationship with member / Reason, Action and resolution
SUB ID , ZIP CODE and Mile Radius
What is https://www.myicarehealth.com/ and BECOME A PROVIDER
Provider submitted a claim and it was denied. Provider disagrees with the decision
Advise Provider that they can request and Appeal or claim inquiry in the Ehealth Portal
Practice/Location Authentication process
What is gather Location ID/Tax ID, Verify Location and gather First name & Last name initial
If the caller does not have an account on Medesis
we must create an External Call and notate under that account.
When searching a CPN member on medesis we need to make sure we select........to look up the member
HUMANA PODIATRY
Bascom Palmer is calling in for a urgent medical request regarding a UHC member's upcoming procedure in 3 days
What is we do not service OPH for UHC and they would have to reach the HP
The number generated after a provider makes the other of the materials on the eHealth Deck Portal
What is Batch Claim ID or Job Order number
Standard documentation includes 3 things, also if a location calls in...the requirements to document when a location calls.
What is reason, action and resolution. Rep first name last name initial and location id/tax id
Health Plan called with mother of member on the line regarding routine benefits , we must document
Call representatives First Name Last name initial , name and last name of mother and relationship, as well as routine benefit information.
Podiatry Provider with member on the line calls to find information regarding members benefits
We advise members podiatry benefits are directly with the HP as we only assist with finding locations in members area