csm
Where would you go to check frequency for code member
Custom report then plan benefit detail
Where would you go to check annual max and ded
topic-plan benefits-financial
can a member with ppo plan see a oon provider
YES!!!!!!!!!!!!!!!!
can we update address
false
What are the three pieces of information needed to for member to authenticate them
Member id
member name
dob
What do you do if member has called several times and can't find a provider
show empathy
widen search
call provider
follow up
Where would you find group name and number
policy detail
Is there a waiting period for member on csm
NO!!!!!!!!
Is the grass green
sometimes
if johnny called to speak for tina and he is not on the phi in csm what do you do
get consent
offer to call mms to get them a form done for phi
Does a member have a deductible if so where do you find it
No!!!!!!!!!!!!!!!!!!!!
where would you see tooth history
utilization history
can we fax the member a eob
no
Can we talk about our day with members
yes keep it simple
what are the three pieces of information you need from the provider
npi or tax id
name of provider
address
where do you find the fee schedule
custom report then fee schedule
What information do you need for the fee schedule
network id from member and click providers name on interaction tab and contract match with agreement id
can you send a random provider a eob without information
no!!!!!!!!!!!
do we get paid friday
true!!!!!!!!!!!!!
if provider only has the members dob and name can you move forward
if they have address
What is the allowable amount how would you read it
covered 100% to the allowable amount
is everything covered at a 100% where do you find out
you have to check under plan benefit then category summary
Can you email provider fee schedule
no only fax!!!!!!!!!!!!
are we gone pass the test
we better!!!!!!!!!!!!!!!!!!!!
can you fax or email phi
fax