Insurance
Even if a member never goes to the doctor all year, what specific cost must they still pay every month to keep their plan?
The Premium
Who can usually use OneImaging?
Eligible employees, spouses, and dependents of contracted self-funded employers.
What documents should be moved to the New stage?
Imaging orders only.
What is a mandate?
Employer requirement to use OneImaging for certain procedures.
What information can be used to search for a member?
Name, phone number, or email.
True or False: Meeting your deductible means the insurance company will now pay for 100% of your medical bills.
False. (After the deductible, the member enters the Coinsurance phase ).
What should you check to confirm eligibility?
The implementation matrix.
What is the purpose of the Triage stage?
To review and correctly classify incoming documents.
What happens if a member books a mandated procedure outside OneImaging?
Prior authorization is stopped and member is redirected to OneImaging.
What search filter should be selected?
“All” (active and inactive members).
What process confirms a service is "medically necessary" but is not a guarantee that the insurance company will pay for it?
Prior Authorization.
If eligibility is uncertain, where should you escalate?
#member-services-ops Slack channel or Team Lead.
What happens if documents are misclassified?
It may cause PA delays, errors, or miscommunication.
What is a Stop File?
Daily report of members stopped from booking outside OneImaging.
What member information is commonly required for verification?
Name and DOB.
If a member visits an Out-of-Network provider, what separate cost requirement might they have to meet before insurance pays anything at all?
A separate Out-of-Network Deductible.
Does everyone automatically qualify for OneImaging?
No.
Where should clinical documents be routed?
Linked to existing In-Review orders.
When can members book outside OneImaging for mandated procedures?
When exception criteria are met.
What is the first step before filing a ticket?
Double-check search filters and spelling.#urgent-tech-team-request Slack channel.
What is the only specific financial milestone a member can reach that actually forces the insurance company to pay 100% of covered services?
The Out-of-Pocket Maximum.
What does OneImaging help employers achieve?
Reduce healthcare and imaging costs.
What happens to non-relevant faxes?
Routed appropriately, not moved forward.
Why do employers use mandates?
To control costs and coordinate care.
What should you do if you cannot find a member?
File an Eligibility Failure ticket.