HIPAA
Grievances
Solutran
WELL MED
MISC.
100

Someone who is able to get detailed information on an account, but requires paperwork- 

What is an POA

100

What are the 5 W"s of grievance Documentation 

Who what where when Why and How

100

How to access benefit information for members 

100

Where to locate the Claim address Maestro- 

review medical claims sections on summary tab

100

Where do you find an MCO for a member who is disenrolled

What is Marx

200

what info can we give a Broker 

Share Basic Information without authentication. This information is publicly available.

200

Do we file Medicaid grievances

No

200

 where do we go to verify who the vendor is

EOC or Wellness Tab

200

Where to locate the PA Auth phone #

well med #s  in SOP CSP Facets Delegated Medical Groups - WellMed Texas 

200

 website for Submitting and tracking requests

What is the EWD Portal 

300

 What must we verify before speaking to a caller 

what is first and last name, month and year of birth

300

What other things have to be done for transportation grievances

What is email the vendor 

300

How does the member get access to their benefit b4 the card is mailed

Downloading the 

mobile app

300

Who does medical appeals

 UHC handles all

300

What is the SOP that tells us what we are to put in wrap up


System Process - Wrap Up Interaction KM1005177

400

When member gives verbal permission, what can we disclose to an auth rep.?-

 All or exactly what the member has clearly given permission for

400

What are the 3 main SOP used for Grievances 

3 main SOPs- Grievance Handling , Wellness Benefits Transportation, Grievance Categorization 

400

Customer Service Number-

what the agent #  855 395 6597

400

What SOP for WellMed- 


CSP Facets Delegated Medical Groups - WellMed Texas

400

what is Skilled care 

OT, Skilled Nursing, Speech, PT, Day Care Services

500

What SOP do we go to in order to review info that can be given out?

Hipaa Index 

 KM1007482

500

When opening other intents to assist the member please put the P-  # in the resolution ie locate a new provider, looking up claims

True or False

False

500

 where can we look if Member is not sure what items can be ordered

what is the catalog or SOP 
Solutran - 2022 OTC + Healthy Food Benefit KM1302200 

500

What phone # would we provide to a dr office for a claim 

800-550-7691

500

 covers Custodial care as a general rule unless you check benefits


 Medicaid