Hospital Visit
Mock Claim
ID Cards
100

What are some probing question to ask a member visiting the hospital?

Is the hospital INN or ONN?

Is the doctor/provider INN or OON?

Is it an outpatient or inpatient visit?


100

What application is used to perform a mock claim?

Facets

100

What application is used for emailing an ID card?

Nuxeo

200

What fees are associated with hospital visits?

Copay

Coinsurance

Deductible 

200

What is the purpose of a mock claim?

A mock claim is used when a member wants to know if a procedure is billable, covered, or requires authorization

200

What is the recommended browser for Nuxeo?

Chrome

300

Does the hospital visit require prior authorization for member 102800344, if so, who's the vendor and what's the vendors number?

Yes, Utilization Management HCMO

800-672-7897

300

What tabs are used to process a mock claim?

Claim Processing + ITS> Medical Claim Processing + ITS>Indicative

300

What are the most commonly used options for Nuxeo?

Search, Recently Viewed, Favorites, Collections and User Settings

400

What type of deductible does member 102800344 have?

Embedded 

400

What job aid shows how to generate a mock claim?

Create a Mock Claim


400

What job aid is used to show how to email a member a copy of their ID card?

Outbound Email Service 

500

What is the hospital copay, deductible, and coinsurance for an INN visit for subscriber ID 102800344? (Inpatient)

Copay: $250

Deductible: $2,000

Coinsurance: 20% (member responsibility)

500

Double Jeopardy!

Perform mock claim:

subscriber ID- 102800344

provider ID- 88862001

diagnostic code- Z000

procedure code- A5512


500

What template should be selected to send an ID card? 

Member Response Email