State of Tennessee
What is the Medicare copay for 2024?
$240
If a member has Medicare as their primary insurance. What would their office visit benefits be?
They would be covered at 100% since we waive copays for Medicare on this plan
What tool is used to find out the date a claim was received?
Jia
What does CCN stand for?
Claim Control Number
Where would you look to find out if Hearing Tests are covered?
Routine Care > Hearing Sub Tab
Where should a member call with questions about their premiums or for their demographic updates?
State of Tennessee Benefits Office 1-800-253-9981
What is the deductable per person for out of network?
$300
How often should you be populating your time on your time card?
Daily
Look up CCN: 23038338386. What is the allowed amount for this claim?
$164.01
What tab will tell you the copay for a cardiologist visit?
Office visit
What does it mean if a member's claim denied with ineligible code 514?
The member has a Medicare Advantage Plan.
What is the copay for an inn cardiologist?
$25
What member survey are we not able to rebut?
Promoter Score or PS survey
Look up CCN: 23281121763. What information are we needing to process this claim?
Accident Details
Member is calling for benefits for a mammogram, what tab do you check?
Routine care>Mammogram sub tab
Member is calling for gym and fitness center benefits, what are they?
There is no coverage for gym or fitness benefits
Who is the pharmacy vendor for County of Westchester?
Caremark
A provider is calling in needing a claim status for Member ID 373000067718 are we able to assist them?
Yes we can assist provider as the specialized training is only needed for processing claims.
Where would you go to see the status of an appeal for a claim?
Onbase>Reporting
Where in HPDB would you find if a plan allows PPO Exceptions?
General/Group Info > Network/OPI/RBP Subtab
What are the pharmacy benefits for a State Of Tennessee member?
The plan has no pharmacy benefits.
Cancer member is calling for wig benefits, what are they?
Covered for Wigs, toupees, hairpieces, etc. for cancer treatment only
INN - 100% No Ded, OON - 80% after Ded
Max: $500 per CY combined INN & OON
How do you know if an employee is on a Cobra Plan?
The EE status will be 04
The Work status will be 21,22,32,54,or 55.
Mark is calling UMR to update his daughter's other insurance. Her insurance is Medicaid. Which plan will be the primary insurance?
UMR, we do not coordinate benefits with Medicaid.
Member is calling to get benefits for a wheelchair, which tab do you check?
DME