members being billed

Searching for a claim

100

What system would you use to locate a claim at first?

OMNI

200

What article do you visit to locate a claim?

Claim Inquiry Call Flow Process

300

What would be reasons not to escalate members being billed? (Must be full answer)

1. Member was not active with Meridian at DOS 2. Members received and EOB/EOP and not actual bill. 3. Member doesn't have all info req in the template

Claim not found process

100

TRUE  or FALSE -the member should be advised to provide their insurance information to the doctor's office and request that the bill be sent to Meridian.

True

200

List three items you have to include in the comment box.

• Caller Name:
  Caller Phone Number:  
  Relationship to Member:  
  Provider Name:  
  Provider NPI:  
  Clinic/Group Name:  
  Clinic/Group Phone Number:  
  Claim Number:  
  Date of Service:  
  Other Insurance Coverage (name) for DOS:  
  Was a claim or claims sent for reprocessing due to COB: Yes or No  
  Member's Eligibility Dates:  
  Amount Billed on Bill:  
  Account Number on Bill:  
  Bill Statement Date:  
  Collection Agency Name (if applicable):  
  Date of Collections Statement (if applicable):  
  Other Language (if needed):

300

 What is the name of the workbasket we send route to

 CNC_MEMBERADVOCATE_WB

Claim found process

100

DO we select "Is this related to behavioral health"

No

200

What happens if the template is not filled out completely and accurately

Routed back to agent for more info

300

Where do we route the interaction to- if a claim is found  

Escalation Response team

CSAs worklist - routed work

100

TRUE or FALSE:   If a work item is routed back to the agent, the agent must resolve the work item by either correcting the wrong/missing information or contacting the Escalations Team agent via Teams.

False

200

Where do you find any Worklist Items Returned back to agent?

Open OMNI / Omni Dashboard / My Work Tab  

300

Which of these two are the steps to Correct Worklist Items - CLIRT?

1) Click on Ellipses / Transfer / Transfer To - enter Work Queue - enter CNC_MEMBERADVOCATE_WB

2) Open Amysis / Click on Binoculars / Enter NPI Number

 Click on Ellipses / Transfer / Transfer To - enter Work Queue - enter CNC_MEMBERADVOCATE_WB

Escalation resolutions

100

True or false- in some cases you will have to open a log view status intent for documentation 

True

200

 How many days can it take for an escalation Resolution?

Up to 45 days

300

If the member is dissatisfied with the escalation resolution. File a grievance. - Which Article should agent refer to assist the member?  

Grievance Submission Process