True or False?
We are allowed to contact an out of state provider post-service
False
Pregnant member calling stating she is looking for resources to assist in preparing for her baby.
OVIA
A statement sent by your insurance carrier that explains which services were provided, how much they cost, what portion of the claim was paid by the plan, and what portion is your liability.
Explanation of Benefits (EOB)
PHI or NO PHI?
Member needs an EOB emailed to her.
PHI
Provider would like to schedule a P2P for a MRI denial
Evicore
There are now new mail room procedures for sending mail
True
Member inquiring about the price of an MRI of the Brain w/o contrast
Cost Estimation
This FAF Fldr Group (B emulator) is used to view member faxes
LFLD group/sub
You have generated a physical therapist provider listing for a member. Which template do you use?
Provider Finder
Diabetic member needing more lancets and testing strips for their glucose monitor.
Pharmacy Vendor
The Waiver for zero cost share for the treatment of COVID 19 date has been extended for all states to August 31st, 2020
True
Member just finding out they are diabetic and needs help purchasing a glucose monitor.
Livongo (if available)
Social Worker referral
_____ Policy. Once the entire families deductible has been met, then BCBS will begin to pay
Aggraded.
Always remember to copy who, in along with the member, on an email being sent
Yourself. BCC
A claim is denying for an H claim, and the billing provider needs to be contacted.
HOST PLAN
We can send an After-Call Summary to a members email address
Member calling b/c their employer told them they could get reimbursed for certain medical procedures. Member would like to know those procedures
Member Rewards
1 / BA
Spouse calling for her husband, but there is no SAF on file. Which template do you use to send her one?
NO PHI Standard Authorization
Member states they are having back pain, and doesn't know which doctor to see for this.
If a member calls back to speak to a specific HA, we do not have to create a new case when we transfer the member
False.
Member calls in at 6:55pm stating their right leg hurts really badly and looking for inn providers. What additional service could we offer?
24/7 Nurse Line
This application can only be used to view C claims.
IMAGE PLUS (IWPM)
After speaking with the member about an upcoming surgery, you would like to send a TOY. Which template do you use?
TX Remember We Are Here For You
Member was in a car accident where they weren't at fault, and is wondering if they have to pay their medical bills.
Reimbursement/Subrogation