1
What is the standard coding for the following?
- Business Segment
- Admin Location
- Status
- Corporate
- GFM
- Pending Issue
What document should be reviewed when coding the balances in PM Site?
Appendix A File
When do we code Vital Objects?
When group is FLEX. Commonly in NonCov groups.
This is the standard coding for "CLAIMS" field in Benefit Authority.
We always code "YES" in Ben Auth.
When do we code SDC Mandatory in CPM?
If SDC in MA - Benefit Summary is coded as "Best Value"
When setting up CPM MC Cov New Issue, should we also set up the PAs?
Yes, but do not send the password right away.
CPM stands for?
Customer Profile Maintenance
Who are the beneficiaries of CPM?
Plan Admin, Plan Advisors and Plan Members
Name the three regions of CPM.
PROD, UAT and FMO
Should we always code CPM in New Issue groups?
Yes, CPM is standardly coded for New Issue in any scenario.
This tab in the Master App will tell us the Billing Type of the group. What tab is it?
Sig Billing Tab
Give one scenario where Prior Authorization and Provider eClaims should be turned off.
When client has no EHC benefit.
In PM Site, we have the COB Information field. When do we code "INFO" and "UPDATE" for this field?
- INFO = Terminated
- UPDATE = Standard
There is a rule when coding French documents in PDF Description. What is that rule?
Do not copy paste words with accent. Documents will not show on Site since accents are not working properly in CPM.
Three tabs we update in PDF Descriptions.
Booklet, Policy and Custom Forms.
What is the reason why we code Pending Issue when setting up a new group?
So that the client will not be able to view the site prior to the effective date since CPM is a live system.
I have plans A and B linked to Division 001. How many plans/division should be set up in CPM?
One division. We are not coding plans in CPM. They are being added in PDF Descriptions.
This brochures refers to Pay Direct Drugs only. What is it?
Manuscript brochures
This field requires another request and should leave as default upon setting up the group. What is it?
Request for Medical Marijuana Approval
We code this field if all benefits are non-mandatory. Where can we find this field and what is the name of the field?
OPTIONAL - Refusal of Coverage
What is the reason behind coding Terminated Member access field in PM Site?
Members are given 100 days after the termination date to access the site. This is what we call "grace period coding".
PA came back asking why documents are not showing on site. What step/s should you do?
1. Check CPM status if Pending Issue or Inforce
2. Check PA site Authority
3. Check policy and booklet field if coded as YES
4. Check PDF description
Explain the rule in coding Multiple groups.
If client only has one policy number, Multiple Groups = NO
If client has more than one policy number and division is...
Existing in more than one policy, code YES
Only existing in one policy, code NO
When do we relate groups in CPM?
When the group is non-consolidated and when MC is coded as "Unique within contract/plan"
Your plan basis is Mandatory Generic with Appeals. What fields should be coded in CPM?
CLAIM: Request for Approval of Brand-Name Drug
MANUSCRIPT: Mandatory Generic with Appeals
MANUSCRIPT: Mandatory Generic with Appeals Quebec