UHC
B&E/Intake
Claim Basics
Medicaid
DSNP
100

3 ways you can improve the provider experience

What is showing compassion and empathy/resolving the callers issue on the first call?
(Many answers apply here)

100

This template is used for your notes when building a Direct ER Admit case in ICUE.

What is pending for clinical review - acute inpatient?
100

This form is used by medical providers, outpatient facilities and labs.

What is the CMS 1500 claim form

100

United Healthcare has many lines of business but you only serve one. 

What is C&S (community and state)

100

Navigate here to see if 99213 requires an authorization

What is PNL?

200

The mission here at United Healthcare

Helping people live healthier lives and making the health system work better for everyone
200

The provider could not verify the members DOB. Per HIPAA guidelines, you can accept an alternate form of verification.

What is the member's address? 

200
In telling a claim's story, this code explains what service the member received in an outpatient setting.

What is the CPT/HCPCS code?

200

These are critical in determining the providers network status

What is the Network ID and Network Prefix?

200

This plan is what is considered Part C, also known as a DSNP plan

What is a Medicare Advantage plan?

300

Common call types you will handle while employed as a provider service advocate at UHC

What is B&E, Authorizations, and Claim status?

300

Using this command in edge will prompt the system to create your auth notes template.

What is Ctrl+Alt+N?

300

An entity that receives paper claims and transfers the data to an electronic format

What is RMO (regional mailing office)?

300

This is the correct subject and category to document in Facets after quoting eligibility. 

What is 

  • Subject: Membership Record
  • Category: Eligibility inquiry
300

You access this system to verify the members Medicaid eligibility. 

What is DMEVs?

400

You visit this site for all things UHC

What is Sparq?

400

You can not locate a member in Facets. Provider states he/she is sure the member has a UHC policy. You can access this system to verify

What is CDB?

400

In the life cycle of a claim, electronic claim submissions are housed in this system.

What is ECHO?

400

You complete this step if there is an eligibility discrepancy. (note: the states website has already been checked)

What is an enrollment verification via Macess?

400

As a provider service advocate, you change a members PCP in this system

What is GPS?

500

Name United Healthcare values

Integrity
Compassion
Relationships
Innovation
Performance

500

This member has NE Medicaid. The provider is INN. The codes 96130 and 96136 require an authorization. What resource does a provider service advocate use to get this information?

What is the BH EPAL excel file?

500

This tab, on the backend of Facets, shows the check cash date and the check cleared date.

What is the remittance tab?

500

You do not give the UHC subscriber ID for this state

What is the state of MS?

500
After quoting claim status for this Medicare member, the provider asks about the secondary Medicaid claim. On the backend of Facets; you look for _______ on the ______ tab.

What is MediMedi? What is the notes tab?

M
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