Systems
What system do I find authorization information in?
Truchart/Clinix
What are the two acronyms for Troy Medicare plans?
TRY - Troy HMO
TYD - Troy DSNP
How long do you have after each call to document and set your disposition?
5 Minutes
Where can you find a medical prior authorization form?
Is there a deductible on troy medicare plans?
No
What system is used to check claim status?
EZCAP
If a member calls, what should be input into the company field in Five9?
Member - Member ID
What do I do if someone calls in for employment verification?
Escalate to Supervisor, so that they may forward request to Troy Medicare.
A prospective member calls in, they live in Catawba county, are they eligible for a troy plan?
Yes
What is the out of pocket maximum for Troy Medicare HMO?
$4500
What system do we use to view claim images and rejections?
SDS
What template do I use when sending a ticket to update a member’s DOB?
Line 22 on Document - escalated - Templates
Hello!
We have received a call requesting the following information be updated.
o Client Name: TRY
o Caller’s Name/callback number:
o Member's Name:
o Member's DOB:
o Member's ID (if available):
o Address on file:
o New Address & County:
o Requested Changes:
o Reason for request:
o Any Additional Information:
Does home health require prior authorization?
PA required after 14 visits
What is the medical claims address and payor ID?
PO Box 21631 Eagan, MN 55121, payor ID 27034
What is the authorization and appeals department fax number?
910-239-8293
What system do we use to pull EOB’s and see how a payment was issued?
Zelis
What does contracted amount mean on a claim?
This is the discounted amount the provider has previously agreed to for the services performed. If they bill over then the difference between the two amounts will be provider write off.
What is the pathway to find the quick guides on the group drive?
G:\Provider Relations\Customer Support\Customer Support Shared Documents\Troy Medicare Member Services Shared\Quick Guides
What is the pathway on the group drive to find the Returned Mail Log or the Escalation Enrollment log?
G:\Provider Relations\Customer Support\Customer Support Shared Documents\Troy Medicare Member Services Shared
Is Dr. Matthew Block from Scotland Cardiology in-network?
Yes
What systems do we document each call in?
JIRA, Truchart, & Five9
Where do I send a JIRA ticket if a claim is found in SDS but not in EZCAP?
Claims- Missing Claim
What is the copay for a tier 3 drug at a preferred retail pharmacy?
$40 copay
What is the link to find a dental provider?
How do you close a ticket in JIRA?