Systems
Which system is known as the legacy system?
CAS
Which mentor will let you view more details about next steps for an EX code?
EX code guide CCC Provider
Where can you find a member if you only have a name?
ASI
A caller wants to know if a medicaid member has coverage for opioid addiction therapy. How will we complete this process?
Check that the member has active coverage for the policy in CRM and check our benefit grid and then we confirm the benefit details according to the benefit grid and then close our case.
Which phone system do you log into first; Genesys or CRM?
Genesys
Which mentor(s) will you follow at the start of a call? Double points for the full answer.
Incoming Calls & HIPAA Guidelines Overview
In what system can we see if a doctor is contracted with humana?
PAAG
Which screen allows you to view detailed claim data
MHI
A caller wants to check on the status of an authorization. How will we complete this?
View the account in crm and check the plan page, then check the authorizations and referrals quick link or guiding care to confirm the status and provide the information found and close your case.
Which system(s) allows you to view payments made by Virtual Credit Card?
ARI
Which mentor will you follow when quoting benefits?
Verification of Benefits Overview CCC Provider and the benefit grid
Where can we find the guidance for a specific benefit?
Benefit Grid and VOB Table of contents
What does it mean if a check status is Escheated
Has not been cashed in 15 months
A caller demands a supervisor and is calling you names and use non-professional language that may be considered offensive. How will you respond?
Follow our Escalation Procedure CCC Provider and Consult transfer to Oklahoma Medicaid PCC OK Medicaid Escalation Provider.
Which system do you use to view important documents for knowing how to complete a process?
Mentor
Which mentor will tell you how to research payment and verifying reissued check payments
ARI Tool for ACH EFT VCC BOP Payments CCC Provider
Who do IHCP's submit authorizations and referrals to?
OHCA
How many days can it take for a check to arrive in the mail?
14-30 Calander days
A caller is wanting to know how a claim paid. What steps can we follow if we do not yet know the status?
Due to the numerous scenarios that could occur you will follow the Identify claim status document and follow the scenario that is being outlined while referring to CAS as necessary to retrieve any additional information.
Which system lets us view current code editing issues?
Onspring
What is the mentor you will follow for AI AN Escalations?
Oklahoma Medicaid AI AN Overview CCC Provider
Where will you go to check the status of an authorization?
CRM or Guidingcare
What does the HH field in CSI tell us?
Indicates yes or no that the provider’s contract contains a hold harmless agreement.
an IHCP has submitted a claim to humana and it has denied. What steps will we follow?
We will advise that they will need to submit their claim to OHCA.