Plan Information
This plan type is only handled by Cigna and always commercial
What is OAP (Open Access Plus)
What task note should be added if COB hasnt been updated in awhile? Also, is the task note placed in internal or external?
What is "COB has not been updated recently; please advise patient to call insurance company."
External
If you ask about the lifetime maximum and they say "We follow medicare guidelines." What do you input and what task note is used?
Input: Headset
Task note: We Follow Medicare Guidelines
What is wrong with info below and what line can you find this info on Q&A:
Medicare Supplement Plan
Individual Ded: 203.00 Met 0.00
Individual OOP: 2550 Met 506.28
What is line 100;Agent states $203 ($217 for 2022) *For Supplemental Plans ONLY(Medigap), Select NO
If you are the secondary plan and you ask if PA is needed and they adv yes for the Jcode. Do you need to push back and if so what pushback?
Yes; Is that true even when secondary?
If agent is unable to look up account with member ID what push back can be used?
What is "Can you search by name and date of birth?"
What push back must be asked if agent says member has medicare part A as their other insurance?
What is "Does the patient have Medicare Part B?"
Is there anything wrong with the following info?Individual Ded:850 Met 586.43
Family Ded: 3000 Met 1549.25
Individual OOP: 1900 Met:850.00
Family OOP: 6500 Met 1854.23
No; there is nothing wrong with the example.
If plan is covered at 100% do you need to still push back with "Does the deductible apply?"
What is "YES"
Yes
Do we collect INN and OON for and supplement plans?
What is NO; Line 31,32 and 40 of Absinthe Q&A
Agent states that they have located member but it has a future effective date and no current plan. What incomplete reason will you use to process task?
What is "Agent unable to locate active member plan?"
If you have a medicaid call what must you ask while in plan design?
What is spend down. Is there a monthly spend down for this plan and how much as been met.
If agent says specifically for Jcode: Member is responsible for a 60.00 copay and after they are covered at 100% after deductible. Do you need to pushback?
No, there is no need to push back.
If the agent states that the PA on file is under a different diagnosis code what line in the Absinthe Q &A will you find how to proceed?
What is Line 174; “Is there a prior authorization on file with diagnosis code XXXX?”
(Ask using the code in our system)
Agent states network status does not matter on medicare supplement plan. Is there a pushback and what do you input. (What is the Line number on Q&A)
What is No; Line 31 of Q&A; Unknown Collecting IN
Agent states the plan is handled by another department and we are unable to complete benefit verification. What incomplete reason will you select?
What is "Agent provided correct number to verify benefits"
Do you need to push back on the following?
Individual Ded: 1500
Met: 1652.25
What is "No"
What do you prompt if agent says we cant look up codes?
What is ""Can you look up by using a description?" (hover prompt)
What do you select if you ask "can the physician buy and bill?" and they say "If the provider contract allows OR Its according to the providers contract."
What is "Headset
(BCBS) Agent is unable to give network status and provider is not listed on website. What free text will you use and what prompts do you select?
What is:
Free text: I still have some plan questions, but when we get to the benefits can I have both in and out of network benefits?
Prompt: Unknown/collecting In and Out
If representative or IVR can not proceed because we are missing information about the patient or provider what incomplete reason do you use?
What is "Missing input information?"
What should be prompted based off following scenario?
Individual Ded: 1500 Met 1500
Individual OOP: 7000 Met 1689.52
Family Ded: 3500 Met 2587.25
Family OOP: 7000 Met 1958.25
What is "Just to confirm the individual out of pocket is the same as the family out of pocket, correct?"
If you are provided tier benefits what push back will you use?
Which tier applies to this benefit?
What task note is used if the PA on file does not cover all required codes?
What is "Prior authorization required but not on file for XXXX code. Contact XXXX Department at XXXXXXXXXX."