ISET TABS
This tab is used to see the members coordination of benefits
Eligibility- other insurance
When searching by radius, ISET will default to search this amount of miles.
25 miles
RAPLE
Radiology, Anesthesia, Pathology, Laboratory and Emergency services
This system is used to check authorization requirements
NGT- Notification Gateway Tool
True or False: On the claims screen, you can search for claims by searching with the procedure/cpt code
True- it is under the additional filter tab in iset
Claims-notification
For a provider to be considered a TIER 1 provider, what two words does ISET need to say on the left hand side of their contract (Hint: Answer must have both words to be considered correct)
Q&E and BEST
NOBLX
Non-network office based laboratory and diagnostic testing
This platform is used when you need to update coordination of benefits when you are receiving the red errors in ISET. Hint: Also used to update Primary care Physicians as well.
CDB- Consumer Data Base
Use this option to search by claims that have a deductible responsibility
This tab is used to route your claim that needs adjustment to the complex team.
Follow up/route
True or False: You can see if providers are accepting new patients in ISET
True
OCM
Optum Advocacy Compass
Resource member can also utilize online to look for providers.
Rally
How to access the coordination of benefits decision tree
The question mark button on the other insurance tab
This tab can be used to locate a claim letter. IE Locating letter sent to provider about needing medical records
Communication-letters
True or False: When you search for a provider using their phone number, you enter in the entire phone number IE 443-789-1234
False: you can not enter the area code, you can only search with the last 7 digits
SPI
Special Processing Instructions
This platform holds all inbound written communications sent in by the provider or member. (forms, records, etc)
Doc360
True or False: Once you search by the DOS in ISET for a claim, if you then want to search by that claim number only, you need to manually type the claim number in if you have the claim highlighted.
False. If you have the claim highlighted in ISET, and select the search by claim number drop down, iset will prefill the claim number for you so you do not need to type it in.
This tab is used to see how many visits have been used for applicable services IE physical, occupational and speech therapy
Benefit-accumulators
When searching for providers using the Radius option, There is a drop down you can use to narrow down your search for the type of provider. What are the three filters for provider searches.
Primary Physician, Facility, and Specialist
ICN
Inventory Control Number aka claim number
This system is used to check appeals.
ETS- Escalated Tracking System
This button in ISET can be used to resend out a member EOB if they are wanting another copy mailed out.
Reprint- Once you have the EOB open, there is a reprint option you can click and send out to the address it was originally mailed to.