General Applications
A learning management system. A place where you can find: Tests, Assignments, and Training Content.
What is Lessonly?
The dollar amount the member must pay out-of-pocket for healthcare services BEFORE the health insurance plan begins to help cover costs.
What is the Deductible?
TRUE OR FALSE: The pharmacy team is allowed to edit information in ADMIN.
FALSE
Who is our direct supervisor?
What is Carly Younkin.
MBR
What is Member
Used for call documentation. We can also view claims, call notes, and accumulators.
What is Javelina Production?
Each family member will have their own, individual deductible AND a larger family deductible.
What is Embedded?
What are some reasons the pharmacy team would log into ADMIN?
What is to view a MBR's EOB or medical claims, or view MBR's Accumulators.
How does Gravie Care get help with pharmacy questions?
What is: They will slack, to ask questions, to assist members with pharmacy questions.
PVR
What is Provider.
A communication system that allows us to talk to different teams. Allows teams to send us pharmacy questions from MBR's and PVR's. Usually Account Manager's use this more than Customer Care Advocates.
What is SalesForce?
Known as the cost share. It is the division of the medical expenses between the member and the insurance company, which occurs after the deductible has been met.
What is the Coinsurance?
True OR False: We cannot look a member up in ADMIN searching by their MBR ID number.
What is False.
This houses all of Gravie’s processes and has content that you will refer to daily while interacting with members and providers.
What is Guru
OON
What is Out of Network
Used to verify MBR’s plan info. For example, EOBs, pharmacy claims and medical claims. We can also verify if coverage is active or not.
What is ADMIN?
Each family member will contribute to a combined family deductible. They do not have smaller individual deductibles.
Non-Embedded (Aggregate)
True OR False: It is important for the pharmacy team to know the members payment schedule found in ADMIN.
What is False.
True or False: When you request PTO in ADP it is automatically approved.
What is false. Carly will either approve or deny the request.
EOB
What is Explanation of Benefits
Essentially like Google for Gravie. If you have any questions, information can be found here!
What is Guru?
Is the most someone would have to pay for covered services in a plan year. This includes the deductible.
What is the Max Out of Pocket (MOOP or OOPM)?
Can you give a specific reason why we would look at a member's accumulators?
What is: A Member might call in and say they have already met the deductible and OOPM. They are being charged for a speciality medication. We would need to review accumulators in ADMIN to verify.
What is the CVS Backdoor number?
What is 833-828-1039
COIN
What is Coinsurance