TRUE/FALSE
Provider is asking about authorization status, is it TRUE or FALSE, the correct classification/intent is call back/misquote
FALSE!
The correct class/intent is AUTH/REFERRAL - STATUS
what mentor is needed when quoting benefits?
IN PathWays for Aging Comprehensive Benefit Grid
What classification / intent is used in QS when you inform the provider a claim has denied?
claim status / denied claim
Provider is needing a reprint of EOR, what classification / intent will be in QS?
Reprint Request / EOR
what is the correct mentor document for verifying class/intents?
CRM Classifications and Intents CCC Provider
We use PAAG to check provider contract info/credentialing!
TRUE!
provider is calling about accumulations for a member, what classification / intent will you use in QS?
benefits / accums
You need to access a claim located in crm, how do you get there?
1. Access Umbrella Page
2. Use quick links at the top and access CLAIM SUMMARY tab
Benefits / Home Health
Provider is needing to know if they are IN NETWORK, what 2 systems will show you this?
go/pfp PHYSICAN FINDER PLUS
go/paag PROVIDER AT A GLANCE
DUAL means the member ONLY has medicaid
FALSE! Dual means member has Medicare AND Medicaid combined
Provider needs coinsurance information, what classification / intent will be used in QS?
benefits - copay/coinsurance
Provider is needing to know details of a check, what classification / intent will you put in QS?
check status / check details
Provider is requesting to join the network, what classification / intent will you put in QS?
Provider / Request to Join Network
what's the MAIN self-service website our providers use?
Availity Overview CCC Provider
PLEASE make sure to save this, you will need it on calls
Correct class/intent for a G&A status call is Provider/Contract Info
FALSE!
G&A - Status
What is EXCLUDED from home health benefits?
* Homemaker, chore services, and sitter/companion services
* Educational activities such as the remediation of learning disabilities
You are on the claim summary tab in crm, you need more info than what crm is giving you on the first page. How do you get more info within the claim summary tab?
Click the claim number hyperlink in blue to open the claim up fully!
What classification / intent is used in QS when the call disconnects?
Other Miscellaneous / Call Disconnected
Provider is needing to Join The Network, what mentor tells you how to do this?
Provider Issues CCC Provider
*Remember- always send these from your humana email ( go/email ) and never cc the provider on it!
Correct class/intent for an escalation call that's regarding code editing is escalation/code editing
TRUE!
What is the website that shows us government / state funded programs in the members area?
*hint hint* rhymes with ERTHA
Provider is wanting to know the correct process to file a claim, what classification & intent is used in QS for this call?
Claim Status / Filing Instructions
You are assisting a provider with Web Navigation on Availity, what classification / intent will be in your QS?
Web / Availity
Provider is wanting to confirm if an auth has been approved yet, how do you find this?
In CRM go to Umbrella Page, at the top Quick Links search AUTHORIZATION/REFERRAL SUMMARY tab!