Data Entry
Agent provides two letters for their name, which data entry is correct? Aj or AJ
Aj
If the agent states "You'll have to speak with the PA department" or "I don't know" what do you do next?
Select "Not on File" and ask "How to Obtain" questions.
Can we accept a copay for Ship to Home?
Yes
Agent asks where will the services be rendered?
Services will be rendered in the patient's home.
Line 138
If agent advises the provider and practice is OON, what benefits are we to collect?
OON Benefits
Plan is terminated. What data entry is required in external task note?
Input plan is terminated or invalid; no active plan found.
If there is a denied PA on file for longer than a year, what would we input?
Not on file. Line 170
If Ship to Home is not covered, we should GE.
False
Agent states the code E0743 is not pulling up in the system. What do we need to push back with?
NTX-100 Tonic Motor Activation System, was previously identified by generic code E 13 99. Can you please check for that code?
Line 147
If the agent cannot determine the network status of the provider and practice for non BCBS, what benefits are we to try to collect?
Both INN and OON
Agent state's "the reference # is today's date and it is 11:51am central time" Which is the correct data entry?A) Eva L 12122024 1151am Central
B) Eva L 12122024 1151am
C) 12122024 1151AM
B) Eva L 12122024 1151am
Representative initiates or asks to initiate a prior authorization, what do we do?
I am looking to verify prior authorization information, not initiate one. Are you able to assist me?
Are we looking for bundled benefits?
No
When asking "is there a copay/coinsurance for ship to home?" the agent provides bundled benefits (including the device). What push back is required?
Can I have the benefit when billed without the product?
Line 139
If the agent advises the provider is OON, and there are no OON benefits, what do we collect?
Name and reference number and GE the call
Plan type is HMO/POS. Which one should be entered into platform HMO or POS?
POS
It is okay to only obtain PA department name and number, we do not have to ask for fax and website.
False. Line 186 We MUST ask for fax & website even if we get a phone number. If the agent can only provide one method & we asked for others: OK to take.
We are expecting a coinsurance for DME and should PB if given a copay.
True
Agent responds "no" when we ask if there is a PA on file. What PB must be prompt to avoid a requeue?
"You may have the previous code E13 99 on the prior authorization. We recently received our new code E 0 7 43. Could you check if a prior authorization is on file for either of these codes, please?"
Line 177
For BCBS, if agent advises you to check your local for network status, what benefits are we to collect?
INN benefits (No need to check BCBS website for Noctrix)
Agent can not provide cost share for Ship to Home. What task note needs to be entered?
Representative could not provide detailed benefit information.
It is okay to take a PA reference number smaller than 6 digits.
False. Line 194 Ask agent ”can you check that please? I usually get a different answer in similar cases.
If the agent gives a range for the coinsurance (0%-20%), what should we input?
The highest amount
When asking for claims address, BCBS agent says "claims go to your local". What PB do we need here?
"Can you look up the address for the local?"
Line 198
If the agent advises they cannot continue without the Tax ID, and you see that this is a Cigna payer, what benefits are we to try to collect?
OON benefits