Providers
This KC tool will help guide you along the way to assigning a new primary care physician for a member.
PCP Changes DT
DT1012884
This guide provides all of the information that must be verified before taking a phone call from a broker or Agent.
HIPAA Caller Type - Broker/Agent
KM1004106
This KM will provide you with the hours of operation for Saferide.
SafeRide - Dedicated Transportation Team
KM1626053
According to this KM, is it appropriate to contact UHC Dental for appeal status?
Dental Coverage - Call Transfer Guide
KM1006984
Answer: Nah.
This KM guides you through the removal of an Rx COB Removal.
Rx COB Flag Removal Macro
KM1004247
This California rule determines if a member can be seen at the beginning of the following month or must wait an additional month before seeing a newly assigned PCP.
1st and 24th Rule
KM1004094
This KM contains information on how to discuss a member's plan with a non-authorized rep when a member is incapacitated.
HIPAA - Emergency Situation
KM1004969
This KM provides information on the macro for looking up member confirmation codes for Renew Active
Renew Active - Confirmation Codes and Enrollment
KM1764450
This KM outlines Medicare covered dental services.
Dental Coverage - Medicare Overview
KM1663350
According to this KM, this independent entity is used to reviews of LEP reconsiderations.
LEP - C2C Innovative Solutions
KM1007215
This KM contains basic HIPAA guidelines for any call type.
HIPAA Guidelines for All Callers
KM1783351
This KM provides information on the eligibility and frequency a member can have a cardiovascular screening.
Preventive Services - Preventive Screening Details
KM1763702
According to KM1663350, you will need this tool to locate whether or not a specific billing code is covered.
Dental Provider QRG
KM1192952
This KM contains all of the common language used when filing a CAG.
Complaints, Appeals and Grievance Glossary
KM1004774
This KM contains information that must be gained for verification of a Provider.
HIPAA Caller Type - Provider
KM1005726
This tool in KC will guide you on modifying a rider on a member's plan.
Rider Add Change or Remove
DT1014503
According to this KM, to which team should a member be transferred when inquiring about Dentures?
Dental Coverage - Dentures
KM1202633
"If the member is inquiring about dentures, offer to warm transfer to the Specialized Denture Support Team in Genesys/VCC Redirect."
What constitutes a Trustee according to this KM?
HIPAA Caller Type - Trustee
KM1005602
HIPAA Definition - Trustee: An individual or organization authorized to manage and distribute assets placed in trust pursuant to the terms of a Trust document.
This KM will guide you through potential talking points for NPOP calls.
Delinquency - NPOP
KM1007266