Claims
Who do we call when we need a claim to be reviewed?
What is SCIP
What do we use Benefit Explainer for?
What is benefit information, guidelines, cost share, medical policies and contractual documents?
When should we be using Misource?
What is to find system documentation, job function procedures and eLearning.
What is DME/P&O procedure codes that are already programmed in the System; BCBS has always processed these procedure codes and handled customer inquiries about them.
What is classic codes?
How are appeals done?
What is mail or verbal appeal?
When the claim has been adjusted, what do we do next?
What is resolve adjustment?
What tab should we use when using benefit explainer?
What is BPR tab?
When is an ER visit copay waived?
What is:
- The member is admitted into the hospital on the same day as the emergency room visit.
- The admission occurs at the same facility and condition for admission is the same as the condition presented during the emergency room visit.
- The member receives services during an emergency room visit, is stabilized and transferred from the hospital by medical transport to another hospital for treatment only or admission for the same condition.
What code codes in POS 4 (home) are covered 100% only from a par or in-network supplier.
What is premier codes?
What tab do we go to in order to change PCP?
What is 'member' tab?
What is it called when we need more time to adjust claim?
What is complex Claim Adjustment?
When searching Prostatectomy (TURP), who are payable providers?
What is MD, DO, PA and nurse?
What is Under five?
What is Under 5 is a library of informative video clips that cover one subject typically in five minutes or less?
Are we required to give our last name if a member asks for it?
What is no?
- We do have to give them first name, last initial, and the CCN from the inquiry worksheet.
What is listed under 'view programs?'
What is case management phone number and hours of business?
What important information do we need in our adjustment notes?
What is name of SCIP pricer?
What searching Prostatectomy (TURP), what requires manual review?
What is surgical team?
What is KLASC alert has been most recently revised?
What is Autos and URMBT_Anthem Changing to BlueCard?
Do CPAP machines fall under rental or purchase benefits?
What is rental?
Where can we see clinical phone call information (ie call backs?)
What is manage referrals?
What number should we include in our notes for adjustment?
What is Client Service Request number from NCompass?
When searching for breast pumps, what kind of code list does this fall under?
What is premier coding list?
Where do we find special offers for members?
What is Blue365?
What is is a radiological test that is used to visualize the structures of the upper digestive system- the esophagus, stomach and duodenum.
What is an upper gastrointestinal Series?
How many ID cards can we send out per day?
What is 2?