Costs
Omni
Systems
Misc
Scenerios
100
A flat rate for a healthcare cost
What is a Copayment
100
This button in Omni helps an agent see what has happened on previous calls.
What is:
100
This is the number 1 system agents use
What is:
Omni
100
The tool used for civilian Network Provider searches
What is: Network Provider Directory
100
'I had a doctors appointment and the doctor was just Henious to me. I want to do something about it!'
What is:
a Grievance
200
This is the next step if a beneficiary calls in stating they were charged for an MRI they never recieved.
What is:
Offering self service options on our website for Fraud, Waste, and Abuse
(we can also suggest they reach out to that provider afterward)
200
(T or F and Which Document) Provider calls in and states thier practice name, NPI and TIN. They are HIPAA verified.
What is: False
Which Document:
Per PL003 Verifying HIPAA, a Providers' NPI and Tax ID count as the same verifier.
200
This is an accessory system used to view all authorizations and referrals, or complete a network to network change.
What is :
CareRadius
200
What is the number to the Program Integrity Department to Report Fraud and Abuse?
What is either:
Phone number to report on OR027:Program Integrity (Report fraud and abuse) 1-844-886-2206
AND/OR
Fax number and address on OR030:
1-844-734-1266
Health Net Federal Services, LLC
Attn: Program Integrity
PO Box 10310
Virginia Beach, VA 23450-10310
200
I really need to know how much these preganacy appts with my OB will cost.
What is:
maternity care: BL093
Maternity care services include all prenatal care from the first OB visit, labor and delivery, postpartum care for up to six weeks after the birth of the child and treatment of complications. Ultrasounds are covered when medically necessary. Home delivery is covered when performed by a TRICARE network or non-network provider including a certified nurse midwife and follows outpatient cost-shares.
300
A specified amount of money that the insured must pay before an insurance company will pay a claim.
What is a deductible
300
This intent helps when you are looking at an Authorization or referral
What is:
View/Update/New Approval
300
This is an accessory system used to view all faxed or mailed documents.
What is iDocs
(with DOMA as the company that owns iDocs)
300
The number to Express Scripts Customer Service.
1-877-363-1303
Found on common contacts OR027
300
11/20/2023: I am looking to change my plan up because I just moved and it looks like the closest doctor to me if forever away. I cant drive 50 min just to see a doctor, in fact, can you tell me why your network is so small if having TRICARE is some big Resource?? I must have better options than this!
what is:
Use Open Enrollment to change the plan to start on Jan 1, 2024
Use the moving date as long as it is within the 90 day period.
400
The cost of Enrollment Fees for TRR in 2024.
2024 Monthly Premium
TRR Member Only: $585.24
TRR Member and Family: $1,406.22
400
This tab in Omni allows an agent to switch between members on the contract.
What is 
400
This accessory program helps determine if a member is within a prime service area.
What is:
The PCM Selection Guide
400
A piece of equipment that, once approved, is kept with the patient for an extended period of time.
What is DME (durable medical equipment)
400
'Look. I really need this authorization approved, but you guys have denied it. I want to do more about it.'
What is:
An Appeal
500
This is the Current premium payment for a TRICARE Retired Reserve Member and Family Plan.
Per:
500
This tab helps an agent see what has been sent out to a member.
What is:
500
This program helps an agent distinguish whether or not a plan has portability or when effective dates may be for a new plan.
What is:
The Enrollment Matrix
500
T or F AND Why: (in Omni: ADFM, Prime, Group B) I have an auth from 6/15/2023 for my chest pain, and my specialist is saying my symptoms are not a pulmonology problem - that I need to go see a Cardiologist. I can have my Pulmonologist place a referral to the Cardiologist.
What is: True
Why?
EOC. It is the same symptoms and within the Episode of Care for an ADFM - 365 days
500
My husband and I got divorced 6 months ago, and i want TRICARE coverage. I havnt remarried or anything like that.
Enrollment Matrix: Former Spouse new Enrollment
90 DAY EXCEPTION: Unremarried Former Spouses (URFS) have 12 calendar months of the initial eligibility date to enroll and receive the QLE eligibility start date (provided all fees are paid back to the URFS eligibility date). Effective date must be their URFS eligibility date; if a date other than the URFS effective date is desired, then open season and QLE rules apply.