Amazon
Do we handle Amazon RX?
No
Who handles the msft vision benefits
EyeMed
What should you check if you have not received a call for over 10 mins
What should be checked on a claim in IBM that hasn't reached facets before discussing it?
* Who does it belong to?
* Sensitivity
Who is our current Privacy Liason(hint: Check recent emails)
Cameron K
Who approves Amazon Travel and Lodging Benefit
Amazon ASR's
Do you handle the calls for member on Microsoft Gender Affirming Care?
You do not, For any benefit calls, whether the caller is the provider or a member, contact the @MSFT Project Team in Microsoft Teams to handle all calls related to this benefit.
Should you reach out to another CSR via teams to get clarification on their pended inquiry?
Can you search for a claim using the cpt code or DX code?
Yes
Should we connect a non premera member to an employee "I want to speak to Ruth S"
No, review the Corporate operator procedure
Where can you find the list of Team Leads for both sides of the NAOI house?
CSR polices>Meet your Team Leaders
Should you check sensitivity of a prior auth a parent is calling on for their 14 yr old?
Yes
How often should you be using Alice?
5-10x per day
What do you do when unsure on where to route a claim?
When in doubt, tss out!
Do you provide full names to caller or document full names in facets(example: Tss name)?
No, we can use initials for facets and only provide the first name along with the first initial of the last name for the safety and security of our employees.
What vendor are we putting at the forefront for Alcohol, Tobacco, Opioid use, and Cannabis use Disorder
Pelago
Do members need to have a PCP on file for HCP?
Yes, Review the HCP method for clarification
Who do you reach out to for unplanned absences?
TL and WFM aka Scheduling analysts
Can we call a provider in another state without locals approval(hint: Check email from Jessica Collins
Yes, if the circumstance falls to those outlined in the procedure
Do we speak with providers, if they are solo on the line?
Nope, we connect to the provider queue.
How much do we pay when a misquote is sent and approved for OOCR?
We pay double the amount
DISABLE is ONLY for when someone has created an account for someone that they shouldn’t have, logged into an account that is not theirs, or a member has reported the account as compromised.
Anytime you have paperwork time
Who do we transfer a call for something related to Subrogation?
Rawlings
What should we use to ensure we are collecting every required piece to authenticate and what do we use to determine what can be advised?
Auth tool and ppi tool