Audit Trends
These plans are not BOB/DIS/DMM.
What are JAA/MCS?
When the INS CD cannot be found, or the plan is a Jointly Administered Account (JAA).
What is U07521?
As of 06/01/2024 we load all of these, including GA.
What are SHBPs?
If utilized, specialists are still required to verify all information in our platforms.
What is Write-to-Source (WTS)?
Inventory submitted by CGS specialists to work excluded groups.
What are Intakes?
Screen used to verify eligibility (effective/end) dates.
What is the F9 screen?
Researching all Elevance IDs found in the CAQH Portal.
What is "Flipping IDs"?
Allows Specialists to send a letter to a member or group in instances where they do not already have a FUSE work item to route a letter through.
What is an Ad hoc Letter?
Resource referred to currently as Associate Productivity Platform.
What is SmartHelp?
When changed, a new COB LL record is required.
What is Secondary Group Number?
Plans that have Elevance as their hospital carrier and another carrier as their medical carrier.
What are Split Plans?
Used if "Member Found, No COB" or "Too many COB instances..." results are returned.
What is Search Option Three?
Members are added for three days, letter sent and case is immediately closed.
What is the Watch List?
The process for CAQH Specialists to send Medicare or Newborn files.
What are Reassignments?
If not correct, this single character can be a 20 point error.
What is the RC?
These are updated regardless of look back periods.
What are LL Records and Med Note Cross References?
If changed, a new CAQH search is required.
What are alpha prefixes?
Where all Notes must appear in a Fuse case.
What is the Final Decision Screen?
This quick reference guide (QRG) provides Coordination of Benefits (COB) Specialists with a list of approved sites for use during the verification process.
What is the Approved Verification Portals?
FI/FINR/9 ASO groups with CarelonRx.
What is Rx criteria?
Empire pays primary (NT INVT CD).
What is EPRM?
When all members and policies are investigated.
What is End-to-End?
Case/intake number, primacy rule and source of information.
What are the required pieces of information in every Comment?
Team Hillenbrand.
Whose the best team?