Tools
What is the main tool we use for every phone call we receive?
Unified Desktop, Genesys Cloud
Where can we identify the member's Product Type?
Member Tab
What is called the AI tool that helps summarize the CBQ?
PBQ
Name of the site we use to generate the list of providers for the member
FindCare
What is called the department where we transfer the member if the have questions with their On-Exchange policy?
Marketplace
What is the tool we use to check the member's On-Exchange application?
IE3
What is called the total amount that has been paid up to the current date?
Paid to date
What are the three types of benefits for DME?
Purchase, Rental, Repair
What is the 10-digit identification number assigned to healthcare providers, such as doctors, hospitals, clinics, and other medical professionals?
National Provider Identifier
What is the KM article that we use to get the phone numbers to transfer our member's or we need to consult with?
ISG Contact List
What tools do we use to check member's premium payments history?
Anthem Payment Tool(APT), CA Mainframe
What are is the process where-in the member needs to keep their insurance or to pay the missing amounts that were missing?
Reinstatement
What two types of benefits should we provide a member when they do not know who is charging for the service?
Professional and Facility
What are the 2 types of identifiers for providers to make sure member's would be covered?
In-network or Out-of-network
What is the task we use if we need to set a callback for a request of a member?
Promised Action
What tool do we use to check the member's ID card?
SMARTHELP, Clarity, UD
What is the button that you will have to click whenever your member is requesting for an emergency of the reinstatement/termination?
Code Blue Request
What are the questions that we need to ask the member in order to give the correct benefit quote?
Date of Service, Benefit or Procedure code, Place of Service, Will this service be performed as part of a wellness, routine, or screening visit?, Provider Status
Where can we update a member's PCP?
UD or CA Mainframe
What do we tag an interaction if the member does not have an active policy?
Guest Contact
What is the tool we use to check member's authorized representative
CIRS
What is the timeframe for reinstatements?
24-48 Hours
What benefit information should we give the member?
Deductible, Authorization, Copayment, Co-Insurance, visit limits
What is the process where a member will be able to receive care from a healthcare provider who is not contracted with the member's health plan network.
Out-of-Network Referral
What does DMHC? additional points if you can also tell what is CDI,,,,,
Department of Managed Health Care, California Department of Insurance