Rockstars

I got Issues

100

I am a LTSS Provider what is the 2 ways I can join the network

online portal or send email to LTSS [e-mail]

200

Who do I reach out to for Provider Relations regarding SNF/assisted living

Jessie Iden

300

How can I submit an address change to you guys

All Other-Explain that all demographic requests must be submitted in writing, provide the caller with the appropriate market email address

400

You told me the claim paid according to the contract, I dont have the contract that you have can you send me a copy, I insist on having a printed copy of that contract

advise the provider to send an email to the appropriate Regional Provider Contacts List requesting a copy of the contract

500

I am the DR and this patient does not come to most appointments and does not follow my orders, I do not want to be liable when they die, I do not want to be their PCP anymore and request to be removed

Remove Patient From Care - All Other pathing - document in CRM with all the information requested and send a case to the market

Calls out the Doc

100

My member has OI and you have told me that they do not show that in a few of your systems but I am telling you they do, what doc would you be following for this 

Other Insurance Update and Dispute CCC Provider

200

I submitted records and you dont have them, I can see them in Availity, what document would you be following

Missing Medical Records CCC Provider

300

I had a horrible experience with someone previously, they were extremely rude and didnt even give me a reference number, is there anything that can be done, or a manager I can speak to about this, someway to report them. What document will you follow

Escalation Procedure CCC Provider

400

Our claims keep denying saying they are going to the delegate, can you tell me who that is as we didnt know they were delegated

Source of Truth Overview CCC Provider

500

Utilize this document to verify a Providers Authority to receive information on calls for different scenarios

HIPAA Overview CCC Provider

IN Overview

100

What is the State Medicaid Department Name

Indiana Health Coverage Programs (IHCP)

200

What is the Pharmacy for this plan

Centerwell

300

What is the name of the vendor for nonemergent transportation; both vendors

LCP-Medicaid, CareCar-Medicare

400

What is NFLOC

Nursing Facility Level of Care

500

What is the guidance that would be given for a provider who called in stating that all their claims were having a delay in payment for members with Group number 02B264

• . Acknowledge the situation and apologize for the inconvenience.
• b. Advise the provider:
• .
• • We are aware of the issue and are working on a resolution.
• • We don't have an ETA at this time.
• • If the claim has already been submitted, we don't need a duplicate submission.

Route Me

100

Sending a case to CRU for the Integrated plan

• • Service Center: Provider
• • Department: Medicare Claims Research Unit (CRU)
• • Topic: None

200

Sending a case for the Medicaid plan to CRU Physical health claims

• • Service Center: Provider
• • Department: Medicaid Claims Research Unit (CRU)
• • Topic: None

300

This claim has been recouped by I need to balance my books and I need a updated EOR my EOR still shows what was originally paid

•  Service Center: Provider Payment Integrity
• • Department: Customer Service Correspondence
• • Topic: None

400

On Provider Missing Their Payment CCC Provider it states that the process starts with the provider receiving a copy of the check, lets start there what is the routing

• Service Center: Provider Payment Integrity
• • Department: Stop Payment
• • Topic: Check Copy Request

500

The provider wanted to speak with a supervisor and it is after the EU has closed for the day (because we only send our cases when we did not transfer the caller to the EU)

•  Service Center: Provider
• • Department: EU Medical Calls
• • Topic: Medicare

That's some Jargon

100

CRM

Customer Relationship Management

200

ERA

Electronic Remittance Advice

300

BOP/VCC

Virtual Credit Card

400

CAS

Claims Administration System

500

CIS PRO

Contract Information System Pricing Research Operation