Claim Status
Claim status that indicates the claim has been accepted by CAMS and the claims in automated dispatch system for a vendor to accept
CADS
What does reassign means?
Removing the initial vendor on the claim and place the claim back online to look for new tech.
Time frame of when a technician is assigned?
we don't give out an exact time frame/ 80% of the claims is assigned within 24 hours but weather events or remote areas could take it to more than 48 hours depending with the availability of the vendor.
When will the reimbursement be an option for the customer?
When CADS completed and we are unable to assign a technician to the claim.
2 hours from the scheduled appointment time has passed and a diagnosis hasn’t been submitted. CAMS automatically sends a task requesting the diagnosis and will put the vendor portal on CADS hold.
CADS POST APPOINTMENT
1st critical decision point when considering reassignment is
Listening and identifying the reason why the customer is requesting a different technician
How to check the technicians availability?
try to manually assign the claim in CAMS
Every when is the reimbursement provided
once in a 12 month rolling period
The vendor has submitted the diagnosis and our Authorization Dept is reviewing the information to make a claim determination.
REVIEW
The most important question we ask the customer if we are reassigning the claim?
If they have paid the SCF to the initial tech/If SCF is paid or not
Where can a customer upload the POC?
account center /customer portal / customer app
What is the purpose of reimbursement?
To ensure a timely resolution by allowing the customer to use their own vendor when our network cannot secure one.
We sent an email to the customer informing them that Auth has determined it is more cost effective to replace the appliance instead of repairing it
Replacement
What are the three vendor performance statistics you should review before deciding to reassign a claim?
Number of jobs completed, Approval percentage and reassign percentage
An action where we get the attention of a specific department since we need them to execute a specific action.
Tasking
Will we provide reimbursement to the customer if they have started the reimbursement and completed the repair already?
Nope, any works done without prior approval will not be subject to reimbursement.
A claim status wherein the appliance or system has reached its maximum capacity, and the customer must wait for the new term to reset
CLOSED- CAP
What is the overall goal of following the steps outlined in the reassignment process?
Making sure that every choice to change a vendor is well thought out and best for the customer.
Authorization limit of an In-Network Vendor
$100
Where should the customers own tech submit the diagnosis?