Enrollment
The equivalent of "Policy Number" in the AdjudiCare hierarchy
What is Group?
What is a predetermination?
Name that appears on receipts for drug claims submitted EDI
What is Assure ?
What is Claims (or Claim Experience)?
If a plan has a sliding coinsurance, My PBC Benefits will always show this %
What is the lower amount / %?
Dependent and student age maximums will be displayed as
What are Notes?
AdjudiCare codes for health items can be found in this resource
What is the SCRM?
Pharmacy Carrier ID for National
What is 34?
Button you would select to view a particular member's HCSA balance
What is Check HCSA Balance?
Genesys workgroup for National
What is CS National?
Field used to view effective date
What is Coverage Date?
What is Benefit Plan Details?
Screen that will display detailed information for Drug Exceptions
What is Card Exceptions?
Claim Experience will default to sort by this column
What is ID (claim item ID)?
Feature used to send additional receipts or doctor's notes
What is Supporting Documents?
Late Applicant information will appear as
What is Claimant Exception?
Hospital room predeterminations should be submitted for this amount
What is $195?
What screen will tell you how many BGTS a member has used in the calendar year?
What is Test Strip Limit Usage?
Tab used in AdjudiCare to view claim statements
What is Payment (Payment History)?
The Blue Cross that sells the policy
What is control plan?
Path to confirm if there is/are separate rules for children on the plan
What is Class > Quick View > Benefit Plan Conditions?
What is 52 weeks?
ONLY PBC Control plan with an exclusive PPN model
What is Utopia Day Spa?
For 2022, this is the amount that was transferred from Nexus
What is Takeover Amount
Page used to find a member's online portal username
What is Online Claims Access User Accounts?