Benefits
In CSI, going here will give you more information about specific benefits
What are Knowledge Topics
This is not a bill. Members confuse this with that.
What is an EOB
This is the PBM (Pharmacy Benefit Manager) for IFP plans.
What is Express scripts
The name of the system you can access the members premium
Softheon
This is what you select to assist the member with their question.
What is Add task
You need this many pieces of information to authenticate the member
What is three
Wheelchairs, for example, will require this before the provider submits the claim
What is an Authorization
The member says "I got a bill for a $20 copay for my office visit and that is incorrect", you should verify this first.
What are Benefits
This is the list of covered drugs
This is the acronym for the subsidy that helps members with paying their premium
What is APTC (Advanced Premium Tax Credit)
Where you are going to document during phone calls
What is FUSE Pulse Notes
ID number, date of birth, address or this can be included as the three pieces needed to authenticate the member
What is phone number
This is another name for a member contract
What is an SBC (Summary of Benefits/Coverage)
When it comes to claims processing, this is important for who pays first
What is COB (Coordination of Benefits)
This is the category for costly or injectable drugs
What is Specialty drugs
This is the grace period for members without a subsidy, to pay their premium
What is 31 days
The name of the training environment
What is FUSE Stage
This is filled out by the member if they wish to allow someone to discuss their PHI
What is Release of information (AOR) form
This must be met before insurance will kick in with cost sharing
What is deductible
If the member paid up front for their medical services, this is what is done to pay the member
What is Direct Member Reimbursement
This can be done for a review if the member wants a non covered drug
What is a Coverage Determination
Credit cards can be used with what payment method(s)?
What is Pay by Phone and Online account
OH NO! FUSE is down. Use these to track your calls.
What is a Crash Sheet
This is only good for the specific phone call
What is verbal authorization
The EOC category for acupuncture
what is Exclusions (Services not covered)
You would create this if the member received a bill but you cannot find the claim on file
What is a PFU (Provider Follow Up)
Can the dependent make payments using their online account?
What is Fiction?
You are looking for a known issue in FUSE. It is located here
What is the FUSE Knowledge Tool
The member is deceased and someone calls in to discuss their health information. We need to have this type of document
What is Deceased member: affidavit for the collection of personal property or Executor of Estate
what kind of coverage does Ucare have when traveling outside the US and where can you find this information?
no coverage outside of the US and under benefit link: Emergency room services
This would be offered if the claim processed correctly, but the member disagrees
What is an Appeal
This is the Rx Group# BIN# and PCN# for IFP
RX Group #: MNON
BIN #: 022022
PCN: ICS
The member wants to change how they pay their premium and this is the name of the task you will choose
What is Change Payment Method Task
A member is requesting a reference number, what item do you provide them with?
What is an S-Case
This type of POA is NOT eligible to receive a members PHI
What is a Healthcare Power of Attorney