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Omni Intents
Prescriptions
Other Systems
Appeals & Grievances
HIPAA
100
This intent is used to update the language used when we send materials to the member. It can also be used to specify Large Print or Braille.
What is update member preferences?
100
This is the stage where the member has surpassed the Initial Coverage Limit, but not reached the TrOOP.
What is Stage 3 (aka the Donut Hole)?
100
In API, these are the keys you will press to view the TrOOP once you are viewing the claim.
What are F15, F24, F15, and then PGDN?
100
This is the intent you will use to document Appeals and Grievances.
What is Issues?
100
When the member cannot provide their ID #, ALL of these must be verified in order for HIPAA to be considered verified.
What are Full Name, DOB, Full Address with Zip Code, and Phone Number with Area Code?
200
This intent in Omni is not functional and should never be used when dealing with Billing and Premiums.
What is View Premium Statement.
200
This Tier has an average drug cost of 25%-37% of the drug cost.
What is Tier 5 (brand name specialty drugs)?
200
In Portico, this is where you will find the TIN and NPI #.
What is the Identifier Crosswalk?
200
A grievance may be considered oral as long as this is done during the call.
What is finding a resolution?
200
This is the name for information that is restricted because of HIPAA Regulations.
What is Protected Health Information?
300
This is the number of genders you may select from when performing the Update Gender intent in Omni.
What is 7?
300
This is the TrOOP for 2018.
What is $5000?
300
In what program do we look up member submitted forms?
What is FileNet?
300
Appeals must be submitted in this way.
What is in written form, sent to the address in Omni?
300
This is what happens when you a disclosure is made to someone who is note an Authorized Contact and may result in fines and other penalties including jail time.
What is a breach?
400
This intent is used when a member will be moving for less than 6 months and then will be moving back.
What is Out of Area Notification?
400
These two things combined will go toward the Initial Coverage Limit.
What are member responsibility and plan responsibility?
400
This is the program where you will be able to perform Mileage Calculation for members in all states.
What is ABS?
400
This is the turnaround time for an Expedited Pre-Service Appeal.
What is 72 hours?
400
This is the type of plan a member will have when they have Medicaid and Medicare.
What is a DSNP?
500
This intent is used when a member has been cancelled in error.
What is Reinstate Plan?
500
When a member get a prescription filled for a 45 day supply, they would be charged the copay for this.
What is a 60 day supply?
500
In Portico, this is the field that tells you if a provider is a specialist or PCP.
What is the Provider Hat Code?
500

If the Appeals and Grievances Department justifies the need for additional information and documents in the Case File how the extension is in the best interest of the Member or if the member/representative submits a request for an extension, the 30 day standard grievance turn-around time may be extended by this long. 

What is 14 days?
500
You will never use this to verify HIPAA.
What is the Social Security Number?