eligibility
where do you find eligibility periods for a member in member processing?
Benefit Plan
Where do you start a follow up in provider call processing?
Follow up tab
IN THE CLAIMS BOX HOW MANY CLAIMS NATURALLY POPULATES?
THE 4 MOST RECENT
WHERE DO YOU LOCATE A REMIT IN PROVIDER CALL PROCESSING?
UNDER REMITS TAB
WHERE DO YOU CHECK AUTH STATUS?
AUTH TAB
where do you find a members frequencies?
Custom Reports & Benefit Detail Reports
Why is a follow up needed
If a claim is processed incorrectly
WHAT IS ANOTHER NAME FOR ENCOUNTER ID?
CLAIM NUMBER
WHAT CAN YOU INPUT TO LOCATE THE PROVIDERS REMIT
THE ADDRESS
WHAT TYPE OF AUTH IS NEEDED IF A EMERGENCY SERVICES ARE RENDERED OR A PROVIDER PROVIDED SERRVICES WITHOUT KNOWING A AUTH WAS NEEDED?
RETRO AUTH
What are the main 3 pieces of information needed to verify a member?
Member ID, FULL NAME, & DOB
In order to submit a follow up what do you need ?
Follow up template
WHERE DO YOU DOUBLE CHECK IF A CLAIM WAS SENT ELECTRONICALLY OR BY PAPER ?
ZELIS PAYMENTS IN CUSTOM REPORTS
WHAT IS A REMIT?
A KIND OF DOCUMENT
WHAT ARE THE TYPE OF AUTHS?
REGULAR AUTHS, RETRO AUTHS, P AUTHS, OR AUTHS
What other pieces of information can you take from a provider to verify eligibility if they do not have member ID?
FULL NAME, DOB, & SSN OR FULL NAME, DOB, OR MEMBER ID
Where do you find the information needed to submit a follow up?
the claim
WHERE DO YOU FIND THE DENIAL RESON FOR A CLAIM?
NOTES, OR UNDER LINE ITEM
WHEN YOURE INPUTTING THE TO TO FROM DAY WHAT SHOULD YOU DO?
3 DAYS PRIOR TO THE DATE GIVEN AND 3 DAYS AFTER
HOW DO YOU READ AUTH THAT HAS SOME APPROVED SERVICES AND SOME DENIED SERVICES?
READ ALL THE ONES THAT APPROVED AND READ THE ONES THAT ARE DENIED AND THE REASON
Can a member have more than 1 active plan? if so where will you find this in member call processing?
Yes, Benefit plan, More eligibility periods
What is the department that you send a claim to for follow up?
DENTAL REIMBURRSTMENT?
WHERE CAN YOU FIND A EOB FOR A PARTICULAR CLAIM?
IN THE ATTACHEMENT SECTION OF THE CLAIM
WHAT IS THE DOCUMENT TYPE?
REMITTANCE
BY PAPER ONLY