Accessing an auto letter in ISG, while in Inquiry Tracking
What is to type 17 in the bottom right hand corner (corner pocket\ ghost field) or press SHIFT F5?
200
CIRS and its use
What is the Corporate Individual Rights Systems? It is used to find authorization to who protected health information can be disclosed per the member’s authorization.
200
This must be fulfilled within 7 days BY LAW to avoid a fine
What is a SBC Request?
200
BSI
What is the Benefit Summary Information?
200
Decider of medical necessity
What is utilization management?
300
Selecting a letter in ISG
What is typing the letter number in the Selection Code filed and pressing F6?
300
BDS and its use
What is the Business Distributor System? It provides a complete view of the member’s enrollment history and the ability to research routing problems
300
Responsible for enforcing laws and regulations of controlled substances in the US
What is the DEA?
300
Navigation to check administration of plan in SPIDER
What is to select line for PLAN ADMINISTRATION in the BSI?
300
Application to assist with M.D. needs
What is the Web Member Access Emulator?
400
S-640HIXNH
What is a subscriber NH Maternity Letter?
400
WEM and its usage
What is the WebInsure Enrollment Manager? It receives enrollment applications, put them in a common format in loads them into ISG. It allows enrollment application status to be reviewed, correct, cancel, or manually enroll pended applications.
400
Benefit of prenatal benefits for NH member
What is the Maternity Benefit Notification Process- NH
400
Quote this OOP for a couple with a non-embedded plan
What is the family out of pocket?
400
Four items that Benefit quotes include
What is verification of the service being covered, what Anthem pays for the service, member’s responsibility, and any limitations?
500
P-208-ISG
What is a PMG liability denial letter?
500
MAPS and its use
What is the Manual Application Processing System? It is a pre-enrollment system used for paper application.
500
Considered “Sensitive Information” for HIPPA
What is Abortion, Genetic Testing, Abuse, Mental Health, HIV/AIDS, STDs, Alcohol/Substance Abuse, Maternity?
500
Answer for NY Member questioning authorization requirement for psychoanalysis
What is NO?
500
General quote for NP M.D. when member has authorized referral
What is Anthem will generally pay as if the provider were participating?