THE BLUES
SPONSORED BY THE OFFICE OF DIVERSITY AND INCLUSION, THESE COMMON INTEREST GROUPS CONSIST OF EMPLOYEES WHO ARE LOOKING TO GAIN PROFESSIONAL DEVELOPMENT WHILE ENGAGING IN DIVERSITY.
WHAT ARE EMPLOYEE RESOURCE NETWORKS (ERN’S)?
FOR THIS POLICY, THE PCR EXPECTED RESULTS SHOULD APPLY TO HOME CLAIMS, INDICATE A DENIAL AS MEMBER LIABLE AND NOT SPEAK TO PAYABILITY OR STAND-ALONE DIAGNOSIS.
WHAT IS BENEFIT POLICY?
IF A NEW GLOBAL COST SHARE MAXIMUM WAS NOT DEFINED IN A CERTIFICATE OR LOWER TRUMPING DOCUMENT, THIS MUST BE UPDATED, OR A CONFLICT WILL OCCUR DURING TRANSLATION.
WHAT IS THE DISPLAY NAME?
HOUSED WITHIN BENEFIT EXPLAINER, THIS PROVIDES BENEFIT INFORMATION TO THE SERVICING COMMUNITY THAT WOULD NOT OTHERWISE BE DISPLAYED IN EXPLAINER.
WHAT IS THE COMMUNICATIONS TAB?
DURING A SKYPE CALL OR MEETING, THIS FEATURE ALLOWS YOU TO SHARE CONTENT ON YOUR COMPUTER WITH ANOTHER USER.
WHAT IS SHARE YOUR DESKTOP?
EACH YEAR, UAW-BCBSM JOINT PROGRAMS AND LIFE SECURE PARTNERS WITH THIS ORGANIZATION IN THEIR EFFORTS TO FEED HUNGRY CHILDREN THROUGH PROGRAMS LIKE FREE SCHOOL BREAKFAST.
WHAT IS THE UNITED WAY?
THIS TYPE OF PAYABILITY LIMITATION RULE IS NOT QUALIFIED WITH ANY OTHER LIMITATION (I.E. DIAGNOSIS, MODIFIER ETC.) AND IS LOADED ON A SINGLE HCPCS CODE.
WHAT IS A COUNT ME ACCUMULATOR?
WHEN A COPAY IS BEING REMOVED IN ITS ENTIRETY, THE COPAY SHOULD BE ADDED TO THE DOCUMENT AND THIS BOX SHOULD BE SELECTED.
WHAT IS REMOVE MAXIMUM?
CST CERT, CST RIDER AND PCR ARE ALL EXAMPLES OF THESE.
WHAT ARE DOCUMENT CATEGORIES?
WHEN A MEMBER HAS SERVICES RENDERED IN A STATE THAT DIFFERS FROM THE STATE THAT DEFINES THEIR BENEFITS, THAT STATE IS CONSIDERED.
WHAT IS THE HOST PLAN?
IN 2019, BCBSM CELEBRATED THIS MILESTONE YEAR ANNIVERSARY WITH A CAMPAIGN AIMED AT EXPRESSING GRATITUDE FOR THE PEOPLE AND PLACES THAT HAVE HELPED IN OUR MISSION TO MAKE MICHIGAN A HEALTHY STATE.
WHAT IS IT’S 80TH YEAR?
WHEN THIS MESSAGE IS RECEIVED DURING RULE BUILDING, IT IS IMPORTANT TO REVIEW THE RULE STRUCTURE/ROW ORDER BEFORE REQUESTING MANUAL CODING.
WHAT IS AN NPS INCOMPLETE MESSAGE?
IF A COPAY NAME IS GENERIC (NOT SPECIFIC TO IN OR OUT OF NETWORK) AND THE DOLLAR VALUES ARE THE SAME FOR IN AND OUT OF NETWORK, THIS BENEFIT TIER SHOULD BE USED.
WHAT IS THE ANY NETWORK BENEFIT TIER?
IF THE MARKETING STATUS INDICATES THIS IN DOCUMENT EDITOR, NO CURRENT ENROLLMMENT IS ASSOCIATED WITH THE DOCUMENT AND RULES, REGARDLESS OF THE DATE, NO LONGER NEED TO BE UPDATED OR MAINTAINED.
WHAT IS RETIRED?
THIS TERM REFERS TO THE ANNUAL UPDATE OF DEDUCTIBLE/OOP MAXIMUM LIMITS IN THE HSA PLANS.
WHAT IS INDEXING?
THIS QUANTIFIES OVER 200 DIFFERENT HEALTH CONDITIONS TO IDENTIFY WHICH DISEASES OR CONDITIONS MOST AFFECT AMERICANS’ LONGEVITY AND QUALITY OF LIFE. IT IS POWERED BY ANNUAL DATA FROM MORE THAN 41 MILLION BCBS MEMBERS.
WHAT IS BCBSM’S HEALTH INDEX?
THIS UNIQUE IDENTIFIER, TIED TO AN EVENT, CAN BE FOUND ON A NASCO CLAIM AND DETERMINES WHETHER OR NOT A SERVICE WAS COUNTED.
WHAT IS AN NPS FLAG NUMBER?
WHEN CHANGING A COPAY FROM PERCENT TO DOLLARS, THE COPAY TIMING SHOULD BE UPDATED TO THIS SO THAT THE COPAYMENT IS APPLIED PRIOR TO DEDUCTIBLE OR COINSURANCE.
WHAT IS PRE DLCS?
TO ENSURE THAT THE BENEFIT EXPLAINER QUICKVIEW TEMPLATE ACCURATELY DISPLAYS TIER BENEFITS, ALL HOSPITAL TIER DOCUMENTS MUST BE LOADED TO DOC EDITOR USING THIS DOC CATEGORY.
WHAT IS CST RIDER 3?
WHEN A COMMUNITY BLUE RIDER EXISTS IN A BPID THAT CONTAINS A CMM CERTIFICATE, THIS MUST BE REQUESTED.
WHAT IS A GROUP WIDE CHANGE?
NOW IN ITS 11TH YEAR OF THIS PROGRAM, BCBSM HIT A MILESTONE BY WELCOMING 4,704 PHYSICIANS IN 1,738 PRACTICES.
WHAT IS PATIENT CENTERED MEDICAL HOME (PCMH)?
THESE CONCLUSIONS DRAWN FROM EVIDENCE BASED FINDINGS, REPRESENT THE DETERMINATION OF MEDICAL NECESSITY AND INVESTIGATIONAL/EXPERIMENTAL CARE.
WHAT ARE MEDICAL POLICIES?
WHEN REMOVING A BENEFIT TIER (IN/OUT) OR PART OF THE MEMBERSHIP CLASS (INDIVIDUAL/FAMILY) THE COST SHARE VALUE MUST BE UPDATED WITH THIS DOLLAR AMOUNT.
WHAT IS $99999?
THIS GENO TABLE IS THE FIRST ITEM REFERENCED DURING CLAIMS PROCESSING AND IDENTIFIES IF A CLAIM WILL BE PROCESSED THROUGH THE TRIPLE TIER HOSPITAL LOGIC.
WHAT IS MIHMPTAB?
DURING A SKYPE MEETING, THIS FEATURE ALLOWS PARTICIPANTS TO WORK TOGETHER WITH OTHER MEETING PARTICIPANTS BY TYPING NOTES, DRAWING OR IMPORTING IMAGES.
WHAT IS WHITEBOARD?