HIPAA
Claim Processing
Unity
Benefits
Qualfon-Only
100

This caller type shares a disclosure section with the Parent of a Minor Child.

Member.

100

These classes are generally considered controlled substances.

II-V (2-5).

100

Selecting this option indicates you've looked at a piece of information.

Review check box.

100

If it exists, the amount the member must reach before  cost sharing begins.

Deductible.

100
The name of the payroll system.
UKG.
200

This can be partial.

Member's first name.

200
The term for paying the difference between brand and generic drugs, when the brand is chosen.

Member Pays the Difference (MPTD).

200

Task name where the BET and Addendum are located.

View Benefits.

200

The section that typically covers GLP-1 coverage.

Weight loss/anti-obesity.

200

The goal for adherence that must be met weekly.

90%.

300

This, when granted, is only valid for the duration of the phone call.

Verbal consent.

300

The key in RXC to begin a test/trial claim, starting from the Claim Transaction Detail screen.

Shift F11 (F23).

300

In addition to Letter Search Tool, we should use this task for viewing letters.

View Communications.

300

The BET trumps this section of the benefits.

Addendum.

300

Paid Time Off is submitted in UKG; Planned Time Off is submitted in _____.

Verint.

400

When calling this specific type of caller, you can leave the member's name/DOB in the voicemail.

Pharmacies/Prescribers/Clinics.

400

This rejection is represented by "R81."

Claim Too Old.

400

Open tasks have this icon, where as closed tasks have a checkmark.

Clipboard.

400

This section is where we look to see if coverage exceptions are allowed.

Coverage Exceptions.

400

The name of the survey that is sent out bi-weekly.

Your Voice Matters.

500

This authorization type is abbreviated as "EE."

Executor for an estate.

500

The browser-based claim system's name.

JUDI.

500

Unity Tasks are contained within these; also a label for "inbound-PHD/inbound-member."

Interactions.

500

A benefit plan summary must be _____ before being visible to us in the BET.

Certified.

500

The name of the email distro that includes all of leadership, including operations management and site director.

DENPrimeSupervisors@qualfon.com.