Procedures
We do not coordinate with Medicaid, HMO or similar managed care plans with only copayments or fixed dollar amounts.
What is COB?
Will provide High-Tech Radiology UM (and Covera COE integration) services for the 17 Included Health pilot states
What is Health Help?
Used to submit a dispute regarding a QA scorecard
What is the Customer Service QA Dispute form?
Treatment must be medically necessary to be covered; the plan will not cover cosmetic treatments of __________ ________
What is Gender Dysphoria?
Used to confirm Network names for Prefixes
What is the Select Networks list?
Scripts should only be used when we experience an entire network/system failure, and our backup systems are not available.
What is System Down Scripting?
Maternity Support Program
What is Ovia Health?
Hanging up or disconnecting the call via system manipulation that has been investigated and confirmed.
What is Customer Abuse / Attitude of Speaker?
Can Quote Benefits from this Resource
What is the SPD?
Representatives over Certain regions
What is a NDR or Network Development Rep?
This process allows out-of-network providers to negotiate to determine the amount of total payment owed if they do not agree with the Qualifying Payment Amount
What is Open Negotiations?
App available to Walmart associates for weight loss.
What is Fresh Tri?
Is not to be left on an unsecured voice mail.
What is PHI during a callback?
Therapy or interventions with trained professionals to help provide guidance on dietary/lifestyle changes that can assist with weight loss.
What is Dietary Counseling?
A website designed to provide wellness resources, information on living a healthy lifestyle, and making healthy eating choices.
Health Connect Blue
Is a health plan process that, under certain conditions, provides members with short-term, temporary coverage for care received from a formerly participating provider.
What is Continuity of Care?
Associates to purchase and complete stock transactions.
What is Computershare?
Provide a concierge level of service by proactively educating the caller and addressing any required system/Blue Touchpoint reminders.
What is Appropriate Customer Engagement?
Assist with communication via written text (i.e., email or text (SMS) messaging); or phone messaging.
What is Speech Generating Devices (Talking Aids)?
Are contiguous to Arkansas for the purpose of treating providers as In-State when processing claims.
What are Cities/Counties?
When the “actual provider” has done something to the member directly or if it involves fraud and/or benefit abuse.
What is a True Complaint?
Is a program to help improve health- starting with digestion
What is Cylinder?
Advocacy - Do (the entire section point value)
What is 40 points?
3.1 Take Ownership of Customer's Issue/Concern and Appropriate Use of Tools and Resources -10
3.2 Documentation-5
3.3 Appropriate Customer Engagement-20
3.4 Proactive Service/Concierge Service-5
Is only available to Sam's Club employees and offers care giver support services.
What is Helpr?
Effective July 1, 2025, Arkansas Blue Cross Blue Shield is updating its payment policy to move to a more efficient and transparent tiered payment method.
What is Injections Payment Policy?