Medical Benefits
What system is used to quote medical benefits?
DEBUT
What system is used to check auth status?
CRM auth/ref summary tab!
How often should you use mentor?
On every call!
what 2 systems are used to see if a doc is INN?
PFP or PAAG
You never need go above and beyond for our members.
FALSE! Do this on each call! It starts with you!
Where can you find DEBUT?
CRM
What is the clinical intake team (CIT)?
CIT handles certain medical authorizations, they DO NOT speak with members, ONLY providers!
TRUE or False: You should ALWAYS aux meal for lunch in genesys!
FALSE! You should ALWAYS log off your phone for lunch!
what system is needed to make a premium payment?
EBILLING
You need to read the terms and conditions each time you make a premium payment.
TRUE!
What is a wheelchair covered as?
Durable Medical Equipment DME
TRUE or FALSE: HMO members do NOT need an auth to see a specialist.
FALSE!
TRUE or FALSE: You should never approve your times in tcp!
FALSE! You need to be approving your times DAILY in tcp once they have been corrected!
Are we trained to go over codes / medical claims?
NO, WT to Claims Dep!
You can stay in ACW for however long you want.
FALSE! the goal is 30seconds!
What is an MRI covered as in DEBUT?
Outpatient Advances Imaging Services!
You can search MRI in the search field in DEBUT as well!
Once on the auth/ref summary tab in crm, what should you do to see if an auth is needed?
Click on the Auth/Referral Requirement tab and go through the questions!
What is the goal for ACW / HOLD?
ACW- 30 seconds
HOLD- 60 seconds
(the end goal is 0)
Can we update an OON PCP?
NO! Check PAAG first, then have the provider reach out to our provider relations dep to get recredentialed!
You can make an impact on our members.
TRUE! we always want to leave the member with a smile on their faces, always go above and beyond and be the change you want to see!
Member is having bloodwork done at the hospital, what would you search in debut to quote correctly?
Outpatient Lab Services!
You can just search "lab" in the search field as well! Make sure to quote the copay for where the member is going and give any cost saving opportunities!
TRUE or FALSE: PPO members do NOT have OON benefits!
FALSE! PPO plans have INN and OON benefits!
TRUE or FALSE: You never need to read the terms and conditions when making a premium payment!
FALSE, you should ALWAYS read them for EVERY payment!
Can we activate a spending account card?
NO, WT to Duals Dep!
Member is cussing you out, so you hang up, is this okay?
NO! We have the abusive caller line for these issues! We never hang up on our members!