Member Inquires
Member is calling in about Home Health Services
Who is Case Manager?
Finding the EOC in GPS
Plan Name/Health Policy Documents/View
Steps when a member does not have their ID Number in QNXT
What is Last name, First name
When a member calls in upset about their Extra Benefits Card not working, we file a Grievance? True or False?
What is True
Where would we go to look up members Chronic Condtions VCC Form?
What is Market Prominence
Member is calling because they lost their Extra Benefits Card
Who is OTCHS?
Finding a Specialist in GPS
What is the Menu Navigation/Find Care tabs?
The line of eligibility we use to ordering member materials for a Michigan HIDE member? Walk us through how to do this.......
What is Secondary Line of Eligibility?
Filing a Pre-Service Appeal for a C-SNP member?
What is Creating a Service Request
Where would we go to see who is a CSNP member's Case Manager?
What is Medcompass
877-476-3457
What is the CSNP Premium Payment phone number?
Finding the MBI
Policy Name/View Member Attributes/ Medicare ID
The line of eligibility we use to for ordering member materials for a Virginia HIDE member? Walk us through how to do this.......
What is Primary Line of Eligibility
What information is important when documenting a Grievance?
1. Complaint ( Grievance Complaint)
2. Dates of occurance
3. Partys involved
4.Requested Resolution
5.Name, Member ID and most inportant Time when Call was taken as well as member Address/Phone Number
6.
What System would we use for FIDE, HIDE members to look up CPT Codes?
What is ProPat
Imaging Prior Authorization status
Who is Evicore?
POA or PHI on File
What do you find in the Privacy Restrictions and Authorizations Information Tab
New Jersey member calls in for a PCP change- name lines of eligibility that need to be updated for the PCP change
What is Medicare-Primary and Medicaid-Secondary Lines of Eligibility
A memebrs MRI is denied becasue the plan determines it is not medically necessary. What process may the member use to challenge the decision?
What is an Appeal
What system would we use to look up CSNP member's CPT Codes?
What is Flash Code
Finding a Medication Tier
What is the Formulary
Name the KA we would pull up if a call comes in "ringing out" and the proper way to answer that call
KA 3053-
Where in Assist Edge QNXT would you go to look up CPT Codes
What is ProPat
A member states that their Specialist keeps arriving late to appointments, what type of issue is this?
What is a Grievance.
Amy's dogs name?
Who is Shianna (Shi)