Greeting
Benefits
SOP's
Scattered
Random
100
This three letter acronym is requred to be provided by a health care professional when they want to check a customers claim.
What is a TIN- (tax ID number)
100
What section of BA tells you the coverage for routine physicals
What is Outpatient Physician services- preventive care
100
Where would you find the hours the Advanced Radiology Team are here?
What is the Transfer Matrix
100
Where would you find the timeframe for adding a newborn to a policy
What is Benefit Access- Eligibility section- newborn
100
What hot key pulls up BA?
What is Alt + B
200
If an incorrect date of birth is provided, this number would be an adequate alternative for validation.
What is a Zip code
200
What well woman service is not covered if it's 3D?
What is a Mammogram
200
What standard operating procedure tells you whether benefit information is PHI or not?
What is the Confidentiality Disclosure of Information Call Guide
200
Where in Benefit Access would you find if there is coverage for a dependant for Maternity?
What is Provisions- Maternity Dependant Children
200
What are the two medical management modules that define precertification requirments?
What is PHS and PHS+
300
What reason should you never give for requesting a phone number?
What is "in case we get disconnected?"
300
What are three common components of an outpatient surgery?
What are Surgeon fees, facility fees, and anesthesiology?
300
Where is the document ID for the SOP that tells us the criteria needed for a breastpump?
What is PP1954
300
what section in BA would tell you whether an address change would stick or not?
What is the Method of eligibility transfer?
300
What format of diagnoses code is now obsolete?
What is ICD-9?
400
Where would you go to find if an authorization for release of protected health information has been approved?
What is HIPAA tab in OneView?
400
What section in BA would you find coverage for the Mirena?
What is Family planning- IUD (intrauterine device)
400
What SOP tells you whether you can give the AMI (alternate member identifier) to a health care professional?
What is the Greeting caller verification and closing call handling
400
A customer wants to know when the plan will end if they decide to quit. Where do we find this information.
What is Provisions- Termination
400
What therapy call will you always take?
What is Speech therapy?
500
You receive a call from the Department of Insurance, where would you direct the caller?
What is the Regulatory Service Inquiry Unit?
500
Where would you find coverage for L3000?
What is Medical Equipment & supplies- External Prosthetic appliances
500
We are the supporting party for a customers plan. where do you find the list to help direct the caller for information?
What is TPA alerts?
500
What three sections of OneView show contributions to deductibles and OOP?
What is 360 view, Eligibility tab, and claims tab?
500
Name the four Alliance partners
What is TUFTS, MVP (mohawk Valley Physicians), Health Partners, and HAP (health alliance partners)
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