Coordination of Benefits
What SOP is Coordination of Benefits information in?
What is Eligibility Advocacy
Examples include: Hearing aids and vaccines.
What is not covered by Medicare ?
What tab in ISET is used to look up a provider directory?
What is the provider tab
When quoting benefits what should you also do?
What is offer to look up or status a provider, check into the limits and exceptions tab in AVA/IBAAG, and offer a dashboard opportunity.
Where in CAMS can you go to find the account balance?
What is click on the membership menu 2x, and then accumulators.
Which rule is being described here? A plan that covers a person as an employee (who is neither laid off nor retired) is primary.
What is Rule 4 - Active/Inactive Employee (Laid Off/Retiree)
Covers inpatient hospital stays and inpatient rehab.
What is Medicare Part A?
When statusing a specific provider for a member do you send the information through a CAA Correspondence or a message?
What is CAA correspondence
What are the members breast pump benefits?
What is no charge the annual deductible does not apply. Limited to buying 1 pump per birth. In the case of a birth resulting in multiple infants, only 1 breast pump is covered.
No coverage for:
Where can you find if a member has a card associated with the financial account?
What is from the member screen click 5. Spending Accounts, scroll to the bottom to select the correct sequencing number, and review the "Purse Enabled" field.
Which rule is being described here: If there is no court decree, the plan of the parent with custody of the child will be primary to the plan of the parent without custody.
What is Rule 3 - Dependent Child/Parent Separated or Divorced
Entitlement is due to disability.
What is entitlement reason G?
How do you pull up the national ancillary?
What is through the star in ISET
Is Massage Therapy covered by the members plan?
What is no, it is a plan exclusion.
How can you tell what is covered by a members financial account?
What is from the member screen click 5. Spending Accounts, scroll to the bottom to select the correct sequencing number, click the spending account ID, click 5. Expense Settings, and use the CAMS expense code word document or open the expense you are looking for.
A member will be adding their spouse to the plan and has a question. This plan will be secondary for the spouse and the COB is non-dup. If the spouse has a copay on her primary and they pay at 100%, will that amount apply to the deductible on the secondary policy?
What is No
This is a combination of Medicare parts A and B.
What is Medicare part C?
Is EdgePark considered a nationally contracted provider?
What is Yes
A member would like to know if 70555- MRI, brain is covered by their plan. What benefit would you quote, and what does that benefit state for in network coverage?
What is Major Diagnostic and Imaging- Outpatient, and the benefits are:
Free-standing center: No Charge, after you pay the $25 per occurrence copay, and the annual deductible does not apply.
Hospital-based center: No Charge, after you pay the $40 per occurrence copay, and the annual deductible does not apply.
Where can you find a financial accounts access point (if one is applicable)?
What is click on the membership menu 2x, then accumulators, select the applicable account, and then you can see the Access Point Settings.
When coordinating with automobile coverage would the UnitedHealthcare policy be primary or would the auto insurance be primary in Wisconsin?
What is United Healthcare, unless an EOB from the automobile carrier is received. When an EOB from the automobile carrier is received, coordinate with the EOB (however, do not request an EOB when it is not received in this state).
This happens when a person is eligible for Medicare, but chooses not to enroll and Medicare is the primary Payer.
What is Medicare Estimation?
Is Dr. Ashley Cotton located at 2605 Harlem Road St Joseph Hospital in Buffalo, NY 14225 in or out of network?
What is out of network.
25,000 limit per person per lifetime combined with Preimplantation Genetic testing and Services and Fertility Preservation for Iatrogenic Infertility.
What is the Fertility services Limit.
What is the expense code that would be used for a mental health visit?
What is MN