Process Mastery Quest 1
How can a member request an Explanation of Benefits (EOB) that is older than 7 years?
A. Call the customer service number on the back of their member ID card.
B. Submit a letter requesting the EOB(s) to the claim address on the back of their member ID card.
C. Visit the insurance company's website and fill out an online request form.
D. Email the insurance company's support team with the request.
B. Submit a letter requesting the EOB(s) to the claim address on the back of their member ID card.
Mary would like to get their controlled substances prescription filled via Optum Home Delivery, what should Mary do?
A. Fax the prescription to Optum Home Delivery.
B. Provider to mail a new written prescription to the appropriate Optum Home Delivery address.
C. Allow up to five business days from the date Optum Home Delivery receives the prescription to receive the mail order delivery.
D. B & C
D. B & C
John, who has not updated his COB with UHC, receives a text message informing him that his Coordination of Benefits (COB) update is about to expire. What should John do upon receiving the text message?
A. Contact Optum COB IVR line at 888-262-4001 for the update to a Yes or No.
B. Reply to the SMS message to update their COB status.
C. No response is needed if the member has indicated refusing other insurance in the past and the answer is still no.
D. A&B
D. A&B
How does the No Surprises Act protect members receiving radiology/pathology services at an INN hospital staffed by an OON radiologist/pathologist?
A. It protects members from being surprised or balance billed for OON services received at an INN hospital.
B. It allows members to be balance billed for OON services.
C. It requires members to pay out-of-pocket for all OON services.
D. It does not apply to radiology/pathology services.
A. It protects members from being surprised or balance billed for OON services received at an INN hospital.
True or False: With the Care Cash program, we want to increase members' out-of-pocket burden, decrease member's use of high-quality, low-cost providers, and reduce member compliance with desired care.
FALSE
John who has cancer have a treatment scheduled with Doctor Morrison, but he learned his contract with their health plan will end before their appointment. What should John do to ensure his treatment is covered?
A. Stop all treatments immediately.
B. Ignore the plan's continuity of care benefits and seek treatment elsewhere.
C. Continue receiving care at INN benefit levels if he is in active treatment, subject to the plan's continuity of care benefits.
C. Continue receiving care at INN benefit levels if he is in active treatment, subject to the plan's continuity of care benefits.
What happened to the Synapse Health process introduced in March 2023 for members needing specific DME items?
A. It has been expanded to include more services.
B. It has been discontinued effective immediately, except for breast pump coverage.
C. It has been discontinued effective immediately for all DME items.
D. It has been merged with another service.
B. It has been discontinued effective immediately, except for breast pump coverage.
True or False: Advocate received call which noticeably have unusual pronunciation and lacks a natural accent. The caller identified herself as Ruby Ford. Advocate also got confirmation after asking, “Am I speaking with a bot?” Call has to be disconnected immediately.
TRUE
Sarah wants to use the UHC mobile app to locate a suitable provider. How can Sarah identify DDPs on the UHC mobile app?
A. By looking for a word DDP next to the provider's name
B. By checking for a red circle next to the provider's name
C. By searching for providers with a blue checkmark
D. No indicator
C. By searching for providers with a blue checkmark
What remark code will appear when a prior adjustment has been completed on a claim?
A. 0H
B. 1A
C. 2B
D. 3C
A. 0H