Billing
What payment method is accepted for Binder Payments?
All payment methods
(Bank account, cards account, check, money order)
What details must always be reviewed when quoting benefits?
Eligibility, deductible, copay, coinsurance, and out-of-pocket and mention Allowed Amount
What information is required to authenticate a policy holder calling about themselves if the account was Fully Authenticated by the system?
Name and call back number
Who issues a referral?
Primary Care Physician (PCP)
When can we submit a complaint via Dash?
When related to an INN provider
How long does it take for a payment to post?
24 - 48 Hours
What services are considered “simple radiology”?
Xray and Ultrasound
What information must be verified if the Spuse is calling on behalf of the Policy Holder?
Caller Name, DOB, Call back # and Policy holder Name, DOB and Address
Who issues an authorization?
Provider performing the service
What is the complaint Time frame?
Up to 30 days
What should you do if RX shows inactive due to non-payment?
Offer 96-hour supply or advise pay out of pocket and send RX override form
When is a colonoscopy preventive?
Member 45+ and no colonoscopy in past 10 years
When is HIPAA needed during a call?
When someone else if calling on behalf of a member
How long is a referral valid?
90 days
When can a post-service appeal be initiated?
When claim is processed and member has financial responsibility
How many grace period days does an ONX member with subsidy have?
90 Days
What does DME stands for?
Durable Medical Equipment
Can we send the ID cards for all the members on the account to the Policy Holder?
Yes, we can
How long can an authorization be backdated?
48 hours
When can a pre-service appeal be filed?
When an authorization or precertification is denied
What system is used to verify if a payment was received?
EBPP (Alacriti) and ORMB (Oracle)
What does “allowed amount” refer to?
Negotiated rate between insurance and provider
If a dependent calls about another dependent, what verification is needed?
Full name, DOB, Callback #, dependent 2’s info (Name, DOB, Address) and Authorization (HIPAA or Verbal)
What information is needed to check an authorization?
Member ID, Provider name, DOS, CPT code
How long does the appeals process take?
10–30 calendar days