GMS: Wk4_Day2_AM Review

Why is it important to run a mirror benefit?

• To make sure the claim was processed correctly

• To let member know about their benefits

• To tell the member they owe money

• To make sure we don’t end up reimbursing the member

A member states, "I am going to visit my PCP and may have lab work and an x-ray."

In Benefit Navigator, what should you select to answer the question “What type of service is being performed?”

• "Office Visit" because it covers all services, without the need to go back through Benefit Navigator

• "Office Services" because it covers all services, without the need to go back through Benefit Navigator

• "Office Visit" to quote the consultation, and then go back through Benefit Navigator and choose "Office Services" to quote the lab and x-ray

• Go through Benefit Navigator 3 times, first choosing "Office Visit", then "Labs", and finally "x-rays", to quote all services

While pulling benefits in Benefit Navigator, always keep an eye on the​ (a)   section to ensure you are quoting the correct information.

• Reminders/ Bulletins/ Info / Group Notes
• Links
• Web Browser
• Member Info

Which are the best resources you can use to find information about virtual visits? Choose all that apply.

• ACE Knowledge Article: Virtual Visits

• ProcedureFlow Document: Out of Office Visits

• ACE Knowledge Article: MD Live

• ACE Knowledge Article: Online Visits with your PCP

A first-time mom calls in the middle of the night and says her baby has a slight fever and she's not sure what to do. Is Telehealth an option for her?

• No, children are never covered by telehealth benefits; they must visit the doctor in-person

• Yes, members can access an MDLIVE doctor via phone or video 24 hours a day, 7 days a week for non-emergency medical issues

• Yes, they can go onto the internet and choose any doctor that provides virtual visits

• No, telehealth is only available during business hours to ensure additional services can be provided in the office if needed

What is one key way that you can elevate your role as a CA and help educate members on the resources available to them?

• Let the member know that the best way to get quotes for benefits is to always call BCBS

• Let members know that the only resource for accurate quotes is BCBS customer service

• Refer members to Blue Access for Members (BAM) for self-service functions

• Tell the member that there are many online sites they can use to search for health information

When quoting the Benefit Level, the percentage of the cost that will be covered, you always need to state​ (a)   .

• xx% of the allowed amount
• xx% of the full amount billed
• xx% of the patient responsibility
• xx% of the total charge