Cost Sharing & Cost Containment
Cost Sharing is usually split between this individual and this entity
Who are the employee and employer?
This is the Trustmark in-house vendor for Utilization Management
You can't provide any claim information without using this grid found in the Compliance or Customer Service sections of the BRS
What is the Customer Service Representative Identification Grid?
When quoting therapy benefits, you would use this tool in Family Files
What is Filtering?
This type of employer doesn't have to adhere to Health Care Reform rules when it comes to preventive, emergency and appeals services
What is a Grandfathered employer?
View how many times a provider or vendor called for a member (or when the member called for themselves) here
What is Review Call History?
Sometimes this amount will include deductible, coinsurance and co-pays - sometimes it won't
What is the Out of Pocket Maximum?
This vendor has 3 different versions of their platform 1.0, 2.0 and 3.0
What is AETNA?
These 2 character codes on a claim provide additional information on a service code or a diagnosis code
What is a modifier?
Pass The Potatoes & Pass The Jelly are reminders for what benefit code?
What is ClaimCheck?
You can see any letters Trustmark sent to members and providers in this tab
What is View Correspondence History?
At least 2 covered family members must meet their individual deductibles before the family deductible is considered satisfied when this type of deductible is in place
What is an embedded deductible?
This vendor provides Trustmark clients with access to over 50,000 gym locations
What is Active and Fit?
These 3 character codes showcase how much deductible, coinsurance and out of pocket a member or their family has met per year
What are Accumulators?
This type of therapy may not be covered if believed to be used for developmental delays in patients
What is Speech Therapy?
Services for these types of benefits are often charged as a global fee
What is Surgery or Maternity?
Pre-certification information and the claims address can be seen in this tab
What is Review ID Card?
This type of cost containment kicks in when an insurer covers expenses for an insured due to a loss caused by a third party
What is subrogation?
This vendor specializes in Diabetes management for enrolled members
What is Livongo?
What is Orange?
This type of therapy's goal is to help people reclaim their independence and the ability to perform activities of daily living
What is Occupational Therapy?
You may see a note about rental vs purchase on claims associated with this
What is Durable Medical Equipment (DME)?
Coordination of Benefits notes for a member can be viewed here
What is View Eligibility?
This type of cost containment works toward improving an employee's productivity and is voluntary
What is Employee Assistance Program?
Renaologic and Golden Triangle are the 2 Trustmark vendors for this service
What is dialysis?
DIM, DIN, CLH and MSN are all fee codes you might see on these types of claims - also known as Out of Network Solutions
What is Reference Based Pricing?
Therapy services are typically billed in 15-minute block of time, known as this on a claim
What are units?
This classification helps determine the level of sensitivity or encryption required when composing an email
What is TITUS?
Member's salary and contact information can be seen in this screen
What is Eligibility Index?