Tools and Authorization

What tool do we use to request reissue refund?

• Ventanex

• Check Inquiry

• Trancentra

• Client Console

True or False. We can process manual refund request.

• True

• False

What do we use Trancentra for? Choose one or more.

• Process reissue refund request

• Paper Checks sent by the member

• Process payments

• Copy of the bills sent to the member

What information from Mainframe do we need to pull up check refund of members from Chick Inquiry Tool?

• Confirmation Number

• Check Number

• Account Number

• UM Number

What tools can we use to check on Pre-Authorization? Choose one or more.

• Member 360

• Trancentra

• Solution Central

• Mainframe

• WEM

Only providers can send in a claim. True or False

• True

• False

What information do we need from a provider calling? Choose one or more.

• Caller first name and First initial of last name

• Group Name

• NPI/Tax ID

• Date of Birth

• SSN

Who processes pre-authorizatins for medical services?

• Utilization Management

• Behavioral Health

• AIM

In what instance does a member submits a claim to anthem?

• If the doctor is INN

• If the doctor is OON

• If the doctor requests

Eligible reinstatement scenarios. Choose one or more.

• Premium recieved but not auto applied

• Member did not process a payment

• Terminated prior to grace period ending

• Grace Notice did not generate