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I C.A.R.E 4u
So Claim it
Back to the Basics
Go with the Flow
What's the Term Vern
100

What are the 5 Customer Styles

Professional,Emotional,Chatty,Upset angry frustrated,timid

100

Another Name for a Diagnosis Code

ICD-10

100
This Funding type of plan is when anthem takes all the financial risk and benefits are typically cookie cutter

Fully Insured

100

what should we ensure we do before we provide any information to a caller

Verify HIPAA

100

A set amount of money you pay at first for covered health care services, before your health plan begins paying

Deductible 

200

Active Listening, Paraphrasing, Empathy, Sensitivity and Problem solving are examples of what

Soft Skills 

200

What are the 4 Claim Status

Rejected,Open,Paid,Denied

200

(BLOCK!!) application enables associates to document member and non-member communication preferences for phone, email and fax.

CPSUI

200

Where are HIPAA Authorizations Housed and how long are they on file for 

CIRS 1Year

200

When a member looses their employment status they are able to enroll in this type of plan. no its not a snake

COBRA

300

What are 6 guiding behaviors with "Always Communicate with Confidence and Knowledge"

  1. Avoid phrases that give the impression that you are uncertain 
  2. Use hold and or silence time appropriately
  3. Ask additional probing questions 
  4. Be clear and concise  use simple terms 
  5. Re-frame from negative information in a positive way 
  6. Use proper grammar and phrasing
300

what is the difference between Embedded and Non-Embedded

Embedded- one family member would never satisfy more than their own individual amount.

Non-Embedded-One Family Member may exceed his or her individual amounts and can contribute to the family

300

What are the 3 HIPAA Identifiers for verification

Member Name

Member DOB

Member ID

300

Give the member an opportunity to ask additional questions or discuss topics before closing is an example of what CARE Guiding Behavior

End with a Lasting IMpression

300

This is the type of action that must be completed when handling a 200C Policy

One Day Grievance 

400

What are the three basic skills of situational service

Identifying, Assessing, Adapting

400

(BLOCK!!)which record is sent to the home plan from the host plan and contains all the claim information billed from the provider

SF

400

How Long is Cobra is active for

18 Months

400

when attempting to de-escalate a call what are the guiding behaviors for the L.E.A.D strategy 

Listen Empathize Articulate Do

400

What are Anthems 5 Core Values

Leadership – Redefine what’s possible

 • Community – Committed, connected, invested

 • Integrity – Do the right thing, with a spirit of excellence

 • Agility – Deliver today – transform tomorrow

 • Diversity – Open your hearts and minds

500

What are our Customer Obsession Guidlines

Laser-Focused

Advocate

Proactive Guide

Relationship Centered

500

A child is sharing custody with their mom and dad. both parents are working and have their own policy and are subscribers. what Primacy Rule will apply for this situation.

Birthday Rule

500

(BLOCK!!)what are the 9 types of authorizations that aim handles

  • Radiology (high cost procedures such as MRI, PET, CAT, etc.)
  • Cardiac
  • Radiation Therapy
  • Sleep Therapy
  • Oncology Management - providers requesting any chemotherapy drugs for members in the program with cancer, as described in the section, should be directed to AIM Specialty Health.
  • Genetics Testing
  • Musculoskeletal (MSK)
  • Surgical GI Review of Outpatient Upper Gastrointestinal (GI) Endoscopy
  • Physical, Occupational and Speech Therapy services (Rehab) -  Habilitative Therapies 
500

name two spending accounts that are Prefunded by the employer

FSA, HRA

500

based of the 1996 federal law this is defined as healthcare information that can identify or relates to an individuals medical services.

PHI(Protected Health Information)