Tools and Resources
Site that houses most of the job aids and tools that we will use in our role
What is "April?"
HCBS
What is "Home and Community Based Services"?
A set rate you pay for prescriptions, doctor visits, and other types of care.
What is "Copay"?
This job aid is the main go to for claims research.
What is "C&S and IFP Claims Research"
This is the program where I can do things like enter in my time worked and view my absence balance.
What is "MyHR"
Tool that gives timeframes for appeals, authorizations and claim filing.
What is "Estimated Time Frame Tool"?
HIPAA
What is "Health Insurance Portability and Accountability Act"?
A percentage of the cost of a service
What is "Coinsurance"?
This job aid/tool can help me assist providers with navigating the provider portal
What is "UHC Provider Portal Education Tool"
System used to adjust your schedule when you are stuck on a call or chat during your scheduled breaks or lunch periods.
What is "intradiem"
Team of claims adjusters that are available through chat.
What is "Helping Hands"?
CLIA
What is "Clinical Laboratory Improvement Amendments"
The amount of money you have to pay for covered services before your insurance begins to contribute toward the costs (before the co-share kicks in)
What is "Deductible"?
This job aid provides guidance for using LivePerson
What is "PSO LivePerson Click to Chat Job Aid"
Quality, RCS (repeat contact score) and UES.
What are "metrics that contribute to QVC"
An application/tool that allows you to check if the claim was received by UHC and also displays the journey of the claim
What is "ECHO?"
PIQ
What is "Provider Information Queues"
Maximum amount on which payment is based for covered health care services.
What is "Allowed Amount"?
This job aid provides details on standard call handling, escalations, HIPAA and documentation processes
What is "Advocate Contact Handling OneSource"
System that is designed to keep users informed about communications and updates across lines of business.
What is "411s"
This tool can help with locating the correct phone line or chat to transfer misdirected calls/chats
What is "Redirect Reference Tool"?
EOB and PRA
What is "Explanation of Benefits and Provider Remittance Advice"?
Process where a claim must be submitted for reconsideration before an appeal can be submitted.
What is "Two Step Process"?
This job aid/SOP houses the Spire User Guide as well as links to most topics that we will encounter in our role.
What is "UHC Provider Service Advocate Toolkit"
This site is where you can see why you have received recognition and where you can send recognition to someone who has done a great job.
What is "Bravo"