COWBOYS
What is a folder?
holds the benefit for coverage
what is the difference between balance due and outstanding bill?
Outstanding bill is the total amount due, balance due is actual amount due with credits.
What are the Dental Riders?
Rider A,B,C,D
WHAT IS PERIODONTICS?
GUMS
WHAT IS THE GO TO CATEGORY FOR STANDARD COPAY?
STCO
WHAT IS THE BASE CLAIM NUMBER FOR 30012435600
124356
BEFORE CHANGING A PCSP WHAT SHOULD YOU DO?
CHECK TO SEE IF THE PROVIDER IS ACCEPTING NEW PATIENTS. read the disclosure
WHERE DO YOU ORDER ID CARDS?
FULFILLMENT
WHAT SHOULD YOU SAY BEFORE QUOTING A BENEFIT?
STMC...SUBJECT TO MEDICAL CRITERIA
WHAT IS THE REJECT CODE FOR 901?
PATIENT INFORMATION DOES NOT MATCH
WHAT IS THE WAITING PERIOD FOR BASIC SERVICES?
180 DAYS
THE MEMBER LOST HIS SUBSIDY WHERE WOULD YOU SEND HIM TO ASK WHY?
THE MARKETPLACE
HOW DO YOU FIND THE RATE QUOTE FOR THE PLANS?
IP RATE QUOTE TOOL
WHAT DOES 98K REJECT FOR?
NO PCP ON FILE
WHAT IS YOUR DEPARTMENT ROUTE CODE
LO
PCSP'S CAN BE CHANGED HOW MANY TIMES PER YEAR?
3
MEMBER IS CALLING TODAY TO CANCEL HIS TCA PLAN WHAT IS THE EFFECTIVE DATE?
02/01/2023
WHAT IS THE SPPG CODE FOR A SELECT LAB
LV
if the member does not know if the Dr. or facility is INN/OON what should you do?
Quote both INN/OON.
DID DONALD DUCK WEAR PANTS?
NO
CAN A SUBSCRIBER CHANGE THE PCSP FOR A SPOUSE?
yes
HOW DO YOU ADD A PERSON TO A MARKETPLACE PLAN?
GIVE THEM THE NUMBER AND TRANSFER THEM TO THE MP?
WHAT IS RIDER D?
ORTHODONTICS
WHAT IS THE SPPG CODE FOR AN NDJ PLAN TO ADD A PCP?
DU AND HG
WHAT DOES STMC MEAN?
WHICH MEANS IT DEPENDS ON HOW THE DOCTOR SUBMITS THE CLAIM.