Dept and Vendors
The department that takes both member and provider calls.
What is Customer Service?
The topic that houses information on periodic health exams.
*Hint: Multiple correct answers
What is the Preventive Services or Healthcare Reform topic?
What the acronym ASO stands for.
What is Administrative Services Only?
The definition of "Carrier" (or another way to say it).
What is a health insurance company?
As expressions of God's healing love, Witnessed through the ministry of Jesus, We are _______ in serving our community, Especially those who are poor and vulnerable
(fill in the blank)
What is steadfast?
The vendor that sends out member ID cards and materials.
What is Clarity?
The topic that houses directions on how to order an ID card.
What is the "ID Cards and Member Materials" topic?
The acronym used to describe self-funded, self-insured groups who are ultimately responsible for paying claims for their members.
What is ASO?
The people who hold the health insurance policy.
What are subscribers?
The name of our parent company.
What is Providence St. Joseph Health?
The department made up of clinical staff that review prior authorization requests and claims for medical necessity.
What is Healthcare Services (HCS)?
The topic that has information on breast pumps.
*Hint: Multiple correct answers
What is the DME, Pregnancy or Womens Health topic?
Four of the "ASO Other" groups serviced by the ASO Customer Service team. (Not PEBB or Intel)
What are:
Clackamas County, CollegeNET, Columbia Sportswear, Ortho & Fracture Clinic, SAIF, School District Trust, Umpqua Health
This is who is included in a network of providers.
What are doctors, facilities, pharmacies and medical homes?
Compassion, Excellence, Justice, ? and ?
What are Dignity and Integrity?
The vendor used for high tech imaging prior authorizations.
What is AIM (American Imaging Management)?
The topic that houses information on circumcision benefits.
*Hint: Multiple correct answers
What is the Newborns, Surgery, or Pregnancy topic?
Two of the determinations ASO employer groups make for their members.
What are:
Benefit structure and eligibility requirements
The definition of a copay, a coinsurance and a deductible.
What is:
Copay: Fixed dollar amount paid at the time of service
Coinsurance: A percentage of the amount billed (ex - member pays 20%, insurance pays 80%)
Deductible: The amount that needs to be paid by the member prior to the insurance company paying their portion
The call greeting script.
What is "Providence Health Plans, this is __________, how may I help you?"
The department made up of 3 subsections that is responsible for making sure PHP is not paying out more than we need to on claims.
BONUS: List the three sub departments
What is OFT (Operations Financial Transactions)?
BONUS ANSWER: What is COB, TPL and OPR (Refunds)
The topic that houses information on infertility benefits.
What is the Pregnancy topic?
The main difference between an Open Option and a Personal Option plan.
What are out of network benefits - Open option plans have them, Personal Option plans do not.
Two cost containment measures.
What are:
Prior Authorizations, Referrals, Regulations, Laws, Mandates, Healthcare Reform
What four pieces of information to verify when a member or member representative calls.
What are:
Member name, member ID, member address, member DOB.