Definitions
What is the definition of an adverse benefit determination?
A claim that is denied or underpaid, or a denied Prior Authorization.
Subscriber notes are primarily used for _____ rules.
COB (Coordination of benefits)
Does Pacific Source require JCHAO accreditation?
No, we do not. This information can be found on the Mental Health resource page.
Demonstrate the pantomime for "Brains work differently"
See Holly.
Which type of fruit is known to be radioactive?
Bananas.
What is the definition of male infertility?
Low sperm count, or the inability to fertilize an egg.
Can a Subscriber's wife change the address on an individual policy?
Addresses can be changed for an individual policy, however; only subscriber can change the address.
How do claims process if an injury or illness takes place on a cruise ship?
Treatment aboard a cruise ship is considered International travel, even for U.S. destination cruises. Claims process as any other international claim.
What is Holly's favorite animal?
Elephant
What is the atomic weight of copper?
63.546 u
How does Pacific Source define a medical emergency?
“An injury or sudden illness so severe that a prudent layperson would expect that failure to receive immediate medical attention would risk seriously damaging a person’s (or fetus’) health”.
How many orders should be placed for ID cards for a family of 4 when all individuals need an insurance card?
One. One order will trigger cards to be ordered for every member on the policy who is over the age of 15.
When checking related entities in facets, what letters will be present to indicate if our PSA team handles a group's flexible spending account?
PSAF
What is Holly's favorite flower?
Lilacs
How many planet Earths would fit inside Jupiter?
1300 Earths
Define Gender Dysphoria.
Marked incongruence between one’s experience/expressed gender, and one’s assigned gender.
What is the difference between an individual policy and a group policy?
How applications are received. A group plan sends in applications as a group (typically a group of employees). Individual policies send in applications on an individual basis with no other affiliations.
What is the official procedure if you think you have discovered another representative's misquote?
Please send all potential misquotes to the team lead queue (per standard procedure). Please avoid making statements of guarantee that a claim will be adjusted until after the team lead review has taken place.
What is Holly's Pacific Source phone number? (In Avaya, not my cell).
208-801-4486
What is the average temperature of lava in Fahrenheit?
2,200 degrees
What is the definition of surgery?
The treatment of injuries or disorders of the body by incision or manipulation, especially with instruments. While “surgery” can be very invasive, it also refers to suturing (stitching) a wound, strapping or taping, or other procedures, such as reducing or setting of a fracture.
When filling out the COB template to pend to the COB team: there is a box that asks about a mandate. What does that mean?
This question is referring to whether or not there is a court mandate that requires the other policy to exist. Could refer to child custody, or alimony cases.
How can a member age 15 or older suppress EOB's being sent to the subscriber's address?
Anyone age 15 or older can go into their own InTouch account and choose to go paperless. This will suppress EOBs from being mailed. A subscriber can only choose paperless for themselves, and minors aged 14 and younger. Anyone age 15 and older will need to create their own account and change their profile settings, under Communication Preferences.
Found on the InTouch Tips Resource Page.
What is Holly's fiancée's name?
Russell
What is the ideal PH level for garden soil?
6.0 to 7.0