MAIN TAB
What is the standard status when coding in CPM?
Pending Issue
What is the standard coding for Health Service Navigator for Corporate groups?
Standardly excluded for Corp groups.
When do we code "Refusal of Coverage" in CPM?
If all benefits are non-mandatory.
How do we code SDC in Other Brochures?
If SDC + QC not included - Check PPN only
If SDC + QC included - Check the two fields
CPM stands for?
Customer Profile Maintenance
True or False: We use the Division name as the client name in CPM.
False.
TRUE or FALSE: We code Vital Objects Function when the group is Admin Advantage.
True
When do we code Medical Marijuana Approval?
By client request. No need to code in initial set up.
When do we code Emergency Travel Assistance?
If group has OOC benefit.
Name the three CPM regions.
PROD, UAT and FMO
My plan type is "Flex", what should I code for "Activation Letter Template" field?
FlexLink.
Give one exception when coding Prior Authorization.
Code no when group doesn't have EHC benefit.
What is the rule in coding Extended Care Claim, EHC with HCSA COB and EHC with COB not required?
Extended Care Claim - group has no HS benefit
EHC with HCSA COB - group has HS with COB
EHC with COB not required - group has HS but COB is not required
How can we determine if we have to code Mandatory Generic with Appeals
If the Drug Plan Type in Master App is "Mandatory (with Appeals)"
When we code CPM, who are our beneficiaries?
Plan Administrators, Plan Advisors, Plan Members
What is the rule when coding "Multiple Groups"?
If group has only one policy and one division, code "NO"
If group has more than one policy and division is existing in more than one policy number, code "YES"
What is the role of Online Claims Submission in PM Site?
PMs will be able to submit claims online.
When should we code "Waiver Only" in Forms?
When there is no LTD/STD and Life has Waiver of Premium.
True or False: If my Drug is Pay Direct Drug, I will not code Manuscript in Brochures Tab.
True.
Do we always code CPM in New Issue groups?
Yes
What is the role of Benefit Authority?
Chatbot to read any non-standard coding for EHC/DEN/DRUG
I am currently coding PA Site and is now in the Plan Member Admin Forms. As per manual, the coding should be "No" but it is currently coded as "YES" and already grayed-out. What to do?
Save the screen so that your current codings will be saved.
Go to menu and re-open your policy number and division. The field will be codable this time.
Differentiate the coding between:
Enrolment or Re-enrolment, HCSA Enrolment and Enrolment or Re-enrolment - SA Groups
Enrolment or Re-enrolment - HO benefit without HCSA
HCSA Enrolment - Group has HCSA regardless if HO or SA
Enrolment or Re-enrolment - SA Groups - SA benefit without HCSA
What;s the difference between "Resilience Direct" and "Resilience Secure" in Other Brochures?
Resilience Direct - check if group has no Resilience
Resilience Secure - check if group has Resilience
I coded CPM today with the effective date of November 15, 2019. Is this acceptable? Why or why not?
No. CPM is a live system and everything you code will be viewed by the beneficiaries right away. If the update is effective November, code CPM near the effective date.