HIPAA
WHAT ARE THE THREE PIECES OF INFORMATION YOU MUST OBTAIN IF MEMBER IS NOT IVR VERIFIED?
MEMBER ID, FIRST NAME LAST NAME, DATE OF BIRTH
WHAT INTENT IS USED TO FIND A PROVIDER
Search and Assign Provider
WHO ARE THE TWO TRANPORTATION VENDORS
MODIVCARE AND PMG=COMFORT CARE
WHAT IS A PA AND WHO SUBMITS IT ?
PRIOR AUTHORIZATION AND THE PROVIDER
WHO ARE THE OVER THE COUNTER VENDORS?
SOLUTRAN,FIRSTLINE BENEFITS, AND NAVARRO pharmacy
IF MEMBER IS IVR VERIFIED WHAT INFORMATION IS NEEDED?
FIRST AND LAST NAME
WHAT INTENT DO YOU USE TO SEND OUT MEMBER ID CARD?
Member Materials
HOW MANY DAYS MUST MEMBER BOOK RIDE IN ADVANCE?
AT LEAST THREE NOT INCLUDING SATURDAY AND SUNDAY
WHAT DOES NBAs STAND FOR AND WHEN SHOULD THEY BE COMPLETED?
NEXT BEST ACTIONS AND ANYTIME THEY ARE PRESENT ON A MEMBERS ACCOUNT
WHAT IS THE NUMBER TO THE LANGUAGE LINE AND DO WE TRANSFER THE MEMBER?
8779728847 AND NO WE DO NOT TRANSFER WE CONFERENCE THE CALL
What information must AR PROVIDED WHEN CALLING ON MEMBERS BEHALF?
MEMEBERS FIRST AND LAST NAME,DOB, AND MEMBER ID,AND THE CALLERS FIRST AND LAST NAME
WHAT INTENT IS USED TO SEE IF A BILL WAS PAID?
Review Medical Claim History
HOW MANY MILES ARE MEMBERS ALLOWED TO TRAVEL ONE WAY?
50 MILES
WHAT IS THE DIFFERENCE BETWEEN commitment and compassion embrace and who completes them? And when can you not schedule a commitment?
Commitments are 24 hours only and compassion embrace are 48 hours or more and commitments cannot be scheduled on the weekends. And SMEs complete them.
Do members have a card to for gym membership? What do we provide to member to utilize the gym membership?
no . Renew active code
what kind of information can be discussed with a caller who is not the member or a AR on file?
General information
WHAT INTENT IS USED TO FILE A VERBAL GRIVANCE?
WHEN FILING A GRIVANCE WHERE MUST YOU PASTE FOR APPROVAL BEFORE SUBMITTING?
Complaints, Appeals and Grievances
Compliance 101 chat
WHAT IS THE NUMBER FOR MODIVCARE AND PMG?
MODIVCARE 86641899812
PMG 8668798023
HOW ARE SOLUTRAN BENEFITS DISPENSED AND DO THEY ROLLOVER?
every month first of the month and benefits do not rollover.
What website can we use to check members most up to date Medicaid information?
DMEVS - Member Search
what intent do you use to add a AR on to a members account and who added the AR on the account?
Manage Auxiliary Persons ,the member
WHAT INTENT IS USED FOR DISENROLLMENT AND WHO DO WE TRANSFER THE CALL TO?
Enroll/Disenroll a Member
DEC TEAM
IF MEMBER MISS A APPOINTMENT DUE TO TRANSPORTATION NOT ARRIVING WOULD YOU FILE A VERBAL GRIVANCE OR QOC ?
QOC= QUALITY OF CARE
How do members report completed health activity and is it a warm or cold transfer?
Renew rewards department and warm transfer
What codes do we use in Gen and Estart for breaks and lunches?
not ready-break in gen 26-001 in estart
gen log off and 99-001 in estart