Not sure
What task do we open to reinstate the member?
Manage enrollment task
What's the 5 Ws?
What, Where, When, Who and Why
Opening, AER, Probe, Resolve and Satisfy
What do you use in solution central if the member doesn't have the member ID?
SSN
what tool do we use if Solution central is down and we need to send the member ID.
MAINFRAME
What is a claim?
The bill that the insurance has received from the provider and is requesting for the payment.
Who is Carelon's VP chief country head?
Nicki Agcaoili or sir Nikki
What does EOC stand for?
Evidence of coverage
How long does the physical member ID card arrive on the members end?
14 days
(double points if calendar days)
What does TGA stand for?
Training goals agreement
Benefits & cost and Access documents for EOC
How long does it update for the billing update for demographics?
2 to 3 billing cycles.
If we send to the member their ID card through their email how long does it take for them to receive it?
24bus hours
Cobra is for when member has an account with their employer and they are no longer with their employer but wants to keep their insurance
What's the purpose of ACMP?
check the authorizations
What task do we clsoe first ODG task or Promised action?
ODG
What's the purpose of BSD?
To check if the account if we handle the account
Double the points if they mentioned to also check the state.
What tab do we check to see how many times the member has contacted us
Recent Interactions or interactions Tabs (has to be interactions Tabs)
Address and Contact Information
has to be accurate
Under group tab what drop down do we click to see the name of the employer of the member and Group administrator?
Product or Entity Contacts
What is the entity that you choose in CIRS?
Blue cross blue shield
double point if Blue cross blue shield Association
How many days does the payment of the member to be received by Anthem?
2 to 5 buss. days
24hrs to 48hrs is for the payment to be posted on the account.
The member has Medicaid they they want to enroll in a Marketplace/ On Exchange plan , can they get an account with marketplace and still have Medicaid?
NO check KM for COD (Claim Processing of Medicare and COB - Individual & Small Group ACA Plans)
What does ACA stand for and what does it mean?
Affordable Care Act is a mandate or law
In mainframe you type ca first and bb, what does bb stand for?
Limited Liability