Terminology
A set amount, usually paid monthly, to maintain coverage. Paid by the member and/or their employer
Premium
Why do we need to know smoking status when quoting a prospect/member?
They can be denied coverage for disease related to smoking, if the information is not disclosed to insurer.
I can respond to emails through this platform and may also receive communication from leadership here.
Outlook
What are the 4 functions of five9?
Inbound, Outbound, Voicemail, Email
What do the following plans start with?
PPO
HMO
EPO
PPO - 4
HMO -11
EPO-1
What is a CSR?
Cost share reduction- is a discount that lowers a member’s out-of-pocket maximum, deductible, copays, and coinsurance for the plan year. Each variant is identified by a two-digit code.
What days to we have client services huddle?
Wednesday/Friday
I am sent to a providers office after a claim has been processed or reprocessed.
EOP
Where can you verify an NPN?
Admin Portal
Do AHP plans run on a calendar year or benefit plan year?
Calendar year
A request for payment for a service rendered to amember, submitted to the insurer by a provider orfacility.
Claim
COC
I’m a place you can go when you need answers, information, or resources to help you do your job.I bring together information from multiple departments, making it available for both individual and cross-department use.
Panviva
Where can you access Physical Therapy accumulations?
Meditrac
What are the 4 networks that we use?
Vitruvian care
Vitruvian connect
PHCS
Alliant
What is another word for negotiated rate?
Allowed amount
Where do you find a appeal denial letter if it is denied/processed by UM?
Admin Portal
I’m related to a member’s premium payment and the amount of time they have to bring their account up to date. This applies to policies without APTC.
31 Day Grace Period
I can tell you whether a member has received their debit card. I can also show you their card balance and transaction history.
EBC portal
What are our member ids and who do they belong to ?
AM
What is the difference between EPO and EOP?
EPO- Plans offered to TN members, with in network benefits only.
EOP- A document sent to providers once a claim has been processed or reprocessed, containing payment information, denial codes, and process dates.
What can we do for off-exchange member's that we can't do for on-exchange?
Terminate their coverage
Update their physical address
I can be open, close or have a child....
Workflow
What language do you see when a check has been cashed?
Processed-Paid
How would you explain an on exchange policy vs off exchange?
An on exchange policy means the consumer enrolled through the state or federal market place typically but not always to apply for financial subsidies that may help lower monthly premium costs