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HIPAA Basics
Systems
Account Summary
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Maestro Category/Intents
100
You can make changes on the member's account WITHOUT the member's verbal consent with this caller.
What is POA/Guardian/Conservator?
100
We use this to bring up member information.
What is MIIM/Maestro?
100
We would use this tab to send out a member ID card to the member.
What is Fulfillment tab?
100
Caller wants to make a payment and the card they want to pay with is not on file.
What is CC Department?
100
The intent we use to update a phone number.
What is Update Member Profile?
200
The member is deceased and the caller has questions. The caller is not an Executor, Guardian, Trustee, or POA. We can discuss ...
What is Basic Plan information, Member Claims information and Member Enrollment information?
200
We use this system to track our Grievances.
What is A&G SharePoint?
200
COSMOS accounts has this to look at benefits, but NICE accounts do not.
What is IBAAG?
200
Member is requesting to disenroll and you have found that they do qualify for SEP.
What is DEC Team?
200
The Category we use to Manage a Passport.
What is Plan Category?
300
We can discuss application status and missing documentation with this type of caller.
What is Prospect member?
300
We check this to see if there are any authorizations on file.
What is ICUE?
300
We see how much is satisfied in the Benefits tab.
What is OOP Max?
300
Member is saying they have a home visit with a nurse from UHC.
What is Housecalls.
300
The intent we use to make a payment for the member.
What is Make a Payment?
400
The agent calling in for the member MUST have this on the member's application for us to be able to fully HIPAA verify.
What is the Sales Agent ID #?
400
We use this system to send out a copy of an EOB.
What is EDSS?
400
In this tab we can find application information, including Sales Agent ID#.
What is Enrollment tab?
400
Member needs a Prior Authorization on a medication.
What is corresponding department (MAEAST or MAWEST)?
400
The category we will look under to change a member's address.
What is Member Category?
500
This is needed from the member if there is no one listed on the account and the caller has plan specific questions.
What is verbal authorization?
500
We use this system to see what the member has sent to us.
What is ODM?
500
In the Detailed Benefits part of the Benefits tab, we can find information on the fitness benefit.
What is Additional Benefits?
500
Provider is on the line and they have claims questions.
What is Provider Line?
500
We will be using this intent quite a bit in our LOB.
What is Review Medical Benefits?