Claims & Coverage
This term refers to the process of determining which insurance pays first when a member has more than one.
What is Coordination of Benefits (COB)?
This type of listening should be used during provider calls.
What is active listening?
This button in the lower right corner of Workspaces allows you to enter and view tickets.
What is the green ticket button?
This program collects data from caregivers to verify service delivery.
What is Electronic Visit Verification (EVV)?
This internet celebrity cat was famously known for her irritable expressions, but was, in reality, quite sweet.
Who is Grumpy Cat?
This occurs when someone pays for their own care until assets are low enough to qualify for Medicaid.
What is Spend Down?
This action is considered call avoidance in the Gainwell call center.
What is transferring a call without a proper reason?
This option should be clicked if a Trading Partner account is locked.
What is unlock account?
These services help people needing daily support for an extended period of time.
What is Long Term Care (LTC)?
A famous animated gecko named Martin represents this insurance company.
What is GEICO?
This is the primary purpose of bundled payments.
What is Diagnosis Related Grouping (DRG)
This is the maximum allowable average wait/mute time once a provider is speaking with you.
What is 120 seconds?
This platform allows you to check claim status, eligibility, and view prior authorizations.
What is Workspaces?
This term refers to beneficiaries assigned to a specific provider and needing a form to switch.
What is Lock-In?
She was the first mammal cloned from an adult somatic cell.
Who is Dolly the sheep?
This outlines fixed payment rates for services under Medicaid
What is a fee schedule?
This behavior during a call is unprofessional and not allowed
What is eating or chewing gum?
After Go Live, providers will access Interactive Fee Schedules under the Reference Materials menu, located here.
What is the web portal?
These services include help with eating, dressing, and bathing.
What is Long term Care services?
This famous dog was rescued from a World War I battlefield by an American soldier and went on to star in 27 Hollywood films.
Who is Rin Tin Tin?
This part of a medical claim explains special circumstances like repeat procedures or telehealth.
What is a modifier?
This is how a CSR should empower providers during interactions.
What is educating providers on available tools like the web portal?
This status is an informational message that does not affect claim payment or denial.
What is WARN status?
This team should receive escalations when a provider disputes an error code
Who is the Claims Resolution team?
This Russian dog was the first animal to orbit the Earth.
Who is Laika?