All Baseball
How long does an average MLB baseball last?
6-7 pitches
What is it called when a pitcher throws 4 balls to one batter and none are in the strike zone?
A Walk
When completing an HRAT and a member asks a question about their dental coverage, where should we be confirming their dental plan?
COWA
What is it called when a batter hits a ball out of the field in the fair territory?
A Homerun
What is the name of the knowledge base we should be checking before we ask a resource expert a question?
Joe Nuxhall, he was 15!
If a member is requesting an exception to be put on the Providence plan but is not established with a provider (seen within the last 36 months), can we request an exception?
No, Providence is not open to new patients.
When the team in the field gets two players out on one play, what is it called?
A Double Play
Which codes do we need to determine if an authorization is required?
CPT and DX codes
Launch
Who's jersey was retired across all teams so that number is no longer worn?
Jackie Robinson (#42)
When a member calls in and there is a flag on their account in CIM, when is it required that I review it?
Every time!
When working from the list of assigned members in CoRo, who should I call first?
Nearest due date
When a Provider is checking on claims, how many members can they ask about in one call?
Three.
How do we personalize our calls with our members and providers?
Use their first name in conversation.
What is the oldest baseball stadium in the US?
Fenway Park in Boston.
What does RBI stand for?
Runs Batted In
On a second attempt to call a member, do I create an outreach or encounter?
Encounter
What is the distance between the bases called?
Baseline or Base Path - 90 feet in the MLB
When a caller asks for a supervisor and we cannot de-escalate them ourselves, which process do we use to get them a supervisor call?
"Escalating to a Supervisor" in Expert
What kind of tree are wooden baseball bats made of?
Ash trees (4800 per season!)
When making a plan change, what must we document to ensure they do not keep changing plans?
Whether it's an initial or final plan change.
What is it called when a runner advances to the next base while the pitcher is throwing the ball?
Stealing
If a member's claim is denied and a provider is asking that we reconsider payment, is this a claim appeal or authorization appeal?
Claim Appeal
What government law requires us to verify all callers and determines what we can share?
HIPAA