That Was in the Newsletter
In this resource the letter Q is indicated by "Quebec."
What is the Phonetic Alphabet?
The bucket that complaints are sent to.
Required HIPAA Identifiers for a Member.
To provider 5 star customer service, this denial code can be sent to the eligibility bucket instead of having the provider fax information.
What is 79?
The bucket that ASH Pays claims go to.
What is Claims?
This type of provider may receive a "roster request."
What is Physical Therapy?
You have the right to file an appeal or grievance.
What is APG Rights?
A red and white form used to submit paper claims.
What is CMS-1500?
The bucket where OON provider information updates are sent.
What is DB Bucket?
The team member on the Gold Star Club for May.
Who is Natti?
Complaint type that does not require an outbound call.
What is Quality of Care?
HIPAA identifiers for Chiropractic Providers
What is Address, and Chiropractor's First and Last Name?
The action taken when there is no denial code in the OCR and no notes in prior logs.
What is sending to research?
The bucket to mail requests for MNR approvals.
These Health Plans are currently having a known claims issue with no expected TAT.
What is Aetna, Optima/Sentara, Cigna TPA.
Any indication of dissatisfaction, regardless if you are able to resolve issue on the call. This includes an escalation to a supervisor or after the third call on the same issue.
What is a complaint?
Information able to be shared with members on the same health plan.
What is Eligibility, Benefits, Providers, no referrals.
The address to which overpayment checks are sent by providers.
What is:
Attn: Finance
American Specialty Health
10221 Wateridge Circle
San Diego, CA 92121
This bucket is plan specific and for provider calls only.
What is the Kaiser bucket?
The queue that is used for Fitness escalations that CSS is not to transfer to.
What is the Fitness Member Experience Queue?
Is this a complaint:
Member indicated they don't understand why the are receiving so many letters and thinks it's a waste of paper.
Yes.
Provider calls with a reference number, if the call is within _ hours we are able to give the member's information to the provider.
What is 24?
Medicare requires services in the past to have these two things submitted simultaneously.
What are claims and authorization (MNR)?
This bucket is used to troubleshoot claims issues between clearinghouses and ASH.
What is the Clearinghouse Bucket?