Benefits & Elig
Which proc assists with re-issuing a member id card?
ID Cards: Inquiry and Replacement
What procedure would you use on a corp call?
Corporate Operator calls proc
What step of the BlueCard Home Claims: Customer Service Handling proc details when to contact the provider direct for a members billing?
Major Step 5
What is the deadline for a level 1 appeal, according to proc Complaints and Appeals: Members?
180 calendar days from the date the customer receives notice of the Company’s decision
Which proc assists with mailing info to a member?
Customer Service Admin Process
What is step 5 of a benefit quote?
Research prov contracting status
According to the Call Documentation proc, what are the 4 benefit types you would document?
Which procedure would assist in locating a claim from 4 years ago?
Archived Claims: Retrieval and Restoration
Who receives the decision letter for a member submitted appeal?
Only the member
What examples of transition to probing, does the telephone etiquette procedure provide?
What procedure would you use to create a "travel eligibility letter"?
Coverage verification/ letter of Elig proc
What is step 7 of your call flow?
Assurance statement
Which proc advises Premeras electronic payer id?
Electronic Claims Submission
Which major step of the Prior Authorization/Medical Necessity Review proc would you use for an inpatient request?
major step 3
What tool would you utilize, if a member account was disabled in error?
Member account disabled in error - CSR Tools
What step in Demo and Member info proc tells you how to complete a name correction?
Step 3.3
What proc does step 4 of the call flow procedure direct you to?
PR.OP.CS.3119 - Caller Verification: Customer Service
Which step of the Accident Investigation/Subrogation proc includes the email for member to submit documents?
Step 8.2
What are pharmacy services chat hours, according to the RX Prior Auth proc?
Hours: Monday-Friday 7:30 a.m. to 5:00 p.m., closed Thursdays 9:00 a.m. to 10:00 a.m.
What is the turn around time for a Spri check?
Approximately 3-4 weeks from the date it is routed.
What step of the benefit Level Exception proc includes the exception form?
Step 3.2
When phone is on speaker, what is the exception the Caller Verification proc mentions?
the billed charges are used as the Allowed Amount so that the member is not balance billed
(Proc- International Claims)
How many days after the DOS, does Carelon require the provider to make a Post Clinical Claim Appropriateness (PCCA) request?
2 days
What address is a POA (power or attorney) request sent to?
Premera Blue Cross
Member Appeals Department
PO Box 91102
Seattle, WA 98111-9202