CCD
What do we click on to document our calls?
Open Call Log
Which number on CCD do we use to pull members up in eCIS?
County/Record Number
What is a claim?
A request for payment
If a member is calling with an issue for the quality of care received at a provider, what are we filing?
Complaint
Who are we allowed to share an adult member's PHI with?
PRD/POA
Where do we find the breakdown of our members benefits?
SOB/Schedule of Benefits
Where do we find the household members responsible for a minor in the "History" section of eCIS?
Individual Non-Financial, Relationship
Where do we check a provider's contract status in a claim?
IPA Code
If a member wants to have an authorization we denied reviewed, what are we filing?
Appeal
Can we share an 18-year old's information with his mother if he's still in high school?
No
Where would we find a PRD or POA listed in CCD?
Contacts on Record tab
Where do we find the responsible party for minors in a household in the "Standalone" section of eCIS?
Payment/Second Payment Name
What code is used to explain the reason the member WENT to the provider?
Diagnostic Code
What options to attend a review are available for our members?
Phone, Video, In-Person or Not at All
Where must we always verify a minor's responsible party?
eCIS
Which ID number is listed on our members' ID card?
Alternate ID
Where do we find the eligibility history of our members in eCIS?
History, Post Authorization, Managed Care
What code is used to describe what was DONE at the provider?
Procedure/CPT Code
What system do we use to view C&G cases?
MedHOK
Are doctors in our network considered PHI?
No
Where do we find if a member has other insurance?
Coordination of Benefits
What government entity maintains eCIS?
DHS/County Assistance Office
How long do providers have to submit a claim to UPMC for payment?
180 Days from DOS
What is a members final option if they have exhausted First and Second/External appeal rights?
Fair Hearing (with DHS)
A member's reproduction, mental health, and substance abuse PHI becomes protected at what age?
13