Specialties
What exclusion should you give on every benefits call, regardless of the provider type?
Pre-Existing Conditions exclusion
What Module can you use to search by Claim number?
Claim Processing - Claim History (subtab)
30-45bds processing time
What are the 2 most common broker codes?
99646 - International Student Insurance (ISI)
22024- Insubuy
How many claimless AirDoctor visits does an eligible member get for a 5 month policy?
Two visits
What does OBGYN stand for?
Obstetrics and Gynecology
(Obstetrics) related to pregnancy, labor and delivery, and pre/post-natal care. (Gynecology) is related to female reproductive system, routine pelvic exams/Pap Smear tests, screening
When the claim has processed and denied, but the member/provider disagrees with the outcome
Appeal
This status means the claim has processed
*does not indicate outcome, only completion
PAID
How many destination countries can a member add on their Visa letter?
Up to 10 destination countries
These policy can only have telehealth services with AirDr in the USA.
Student Secure
Does WorldTrips require a referral for a Specialist office visit appointment?
No- no referral or prior auth required, all claims subject to review by examiners with complete MRs
Task the claim 10-15bds turnaround
This claim status means the claim has been reviewed by the claims team, and waiting for the next accounting batch to run for EOB’s to print/mail to member and provider. This doesn’t mean payment, it just means it’s in the final stages of processing.
PAY/HOLD
What inbox are emails sent from if communicating with the Member?
Service Inbox
or
service@worldtrips.com
or
HCCMIS Service
How does a member use the AirDr benefit?
AirDr application
*deductible (if present) due on the app at scheduling
Which exclusions would you look for during a Hematology provider benefits call?
-“All forms of cancer / malignant neoplasm”
- “Birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.”
- “Pre-existing Conditions…
What is a Claim AltID1
UHC claim # (present on claim for UHC policy)
Claim is Pended 241- 'Passport Needed' - what can be submitted?
Complete passport with all pages/stamps OR original airline/travel itinerary or boarding passes
How many levels of Appeals can be done for a denied claim?
2 appeals
1st and 2nd level appeal
After 2 levels upheld, member must appeal to DOI
What User field is the AIRDR coverage listed under in MFM?
User field 17
A member wants to get a colonoscopy, cancer screening, and mammogram done. Which general exclusions would you provide?
-Routine/Informative/Preventative/Screening exclusion
-All forms of cancer
How do you access how a payment was sent for a processed claim?
Advanced Menu dropdown> View Payment/Transaction Information
There was an error in the system when the claim was entered
EXC
What is 1 example of a Call Audit Core Function (Q1)?
ie name 1 call failing error?
Freebee: Notes are not reflected in the system
-Did not verify HIPAA-Was not HIPAA compliant throughout call
-Gave incorrect/incomplete info-Did not answer all questions
-Did not utilize all resources for 1st call resolution
-Did not follow proper escalation/task procedure
Which policies have AirDoctor availability with purchase?
Atlas Travel, Atlas Premium, Atlas Nomad, Atlas JapanSecure, and Student Secure
(Will accept Atlas and SS)