DAILY SYSTEMS
System used for the creation of cases/Prior authorizations. Also to see if a case is on file.
ICUE
When you transfer a caller and provide the information to the next agent before connecting.
WARM TRANSFER
The base of the term/word
ROOT
Maximum amount on which payment is based for covered health care services.
ALLOWED AMOUNT
System that provides the ability to place and receive calls.
VCC
The knowledge management tool used by UnitedHealthcare anytime you need to access Standard Operating Procedures, job aids, or other documents.
Knowledge Central
The greeting you use during call opening directly reflects your personal competence, and confidence to the caller.
CALL OPENING
found in front of the root word
PREFIX
The amount you could owe during a coverage period (usually one year) for health care services your health insurance or plan covers before your health insurance or plan begins to pa
DEDUCTIBLE
We use this system to check appeals for Medicaid and Pharmacy
ETS
The application is used by customer care professionals and resolution specialists to provide information about eligibility, claim history and participating providers.
FACETS
Open call and identify the issue, research issue and keep caller engaged, resolve issue and close call
CALL FLOW
Found at the end of the root word
SUFFIX
A fixed amount you pay for a covered health care service, usually when you receive the service.
COPAY
Tool to assist with researching C&S claims and gives us an overview of how claim processed.
PDAT
Mainly used for routing issues pertaining to eligibility discrepancies, claims or coordination of benefits to other departments
MACESS
Verification requirements for the call that determines the type of information you discuss with callers.
HIPAA
An abbreviation formed from the initial letters of other words and widely used at UHC.
ACRONYM
Something that a person may not be able to do or the most a health plan will cover for costs and services
LIMITATIONS
We use this system to check appeals for Medicare/Medicaid dual eligible members
ATS
Where we can find links to systems we use daily, common SOP's and intake resources
APRIL
An improved approach in our engagement with providers while responding to questions or helping to resolve issues.
POSITIVE ENGAGEMENT
A great in-house place to start when you're decoding acronyms
UHG ACRONYM LIST ON SPARQ
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service
UCR
System used to research members Medicaid eligibility and payor contact information if they are dual eligible.
DMEVS