CPS
CPS most commonly stands for?
Claim processing system
what is a tickler?
a system to identify unresolved issues
Which plan has no waiting period fedvip or cd+?
FEDVIP
How do we find Julian date and calendar?
JIA
What are the steps to finding claim amount in CPS
Select member>Status call>Claim search>Enter DOS
How can you tell if there is a Tickler
CFR & Tickler date
Some prosthetic services may require a review to determine medical necessity.
TRUE
Where do we go to find copay
DPDB>Benefits and claims
Name example of PHI
SSN,DOB
Which form allows UMR permission to disclose PHI to a specific individual?
ARF
How do you escalate complaints ?
escalations@geha.com
what steps would you take to walk a member on how to access their eob on their portal
Goto GEHA.com>Sign in/register>Claims & benefits
what tab in DPDB do you press to see if you would be covered if you got an injury while committing a felony
Plan exclusions
Timely filing is also known as proof of loss
True
If the caller doesn’t have the claim control number, what are two or three pieces of information that you should gather once you know you have a claim status call?
DOS,Billed amount, Provider name
How long do claims reprocessing take?
20 business days
Where can you find coinsurance?
Benefits & claims>dental coverage
what is a missing tooth clause
This provision protects the plan from paying for the replacement of a tooth that was missing before the policy was in effect.
What is the sole purpose of onbase ?
To check documents
The Julian Calendar tells you timely filing? True or False?
TRUE
what does an asterisk mean?
Continue to the next document type
What is the dental GEHA hierachy?
FEDVIP,CD+,LIMITED DENTAL
What Tab do you find the CDT chart?
Attachments
what are the dental classes
•Class A Prevenative & diagnostic
•Class B basic,
•Class C is Major
•Class D is Orthodontics