Benefit management

DPC referral what are steps to take if you see comment DPC referral in comments?

• F5 F7 01 give PPO benefits,

• F3 2 RL see if referral is for provider calling in, confirm they have referral on file, follow tool for DPC benefits.

• F3 1 RL rec'vd info give bens,

• F5 F7 08 give DPC referral bens

What do you do when a provider calls in and states they have been under paid for their services?

• Advise to send in reconsideration,

• start a Monday ticket

• teams claim specialist for review

• Advise to reach out to network who priced claim and have them send over corrected pricing if needs updating.

What is the commercial fax # ?

• 6207927058

• 911

• 6207927053

• 6207931193

Where should we transfer member ID's that start with ZZ###### ?

• AAA

• Zelis

• Allied and the contact # in their card is 833-306-4092 for member claim/ Pharmacy

• Privders Care Network

When a provider says we overpaid we should:

• Make ticket with CS to send a refund request

• Request prov to send this explanation of overpayment or

• Advise prov to send a voluntary refund

• Give them your personal venmo and buy something nice

What is 90 D phone number ?

• 866-306-1880

• 866-306-1882

• 866-306-1883

• 866-306-1884

What do we ALWAYS need for DME ?

• Doctor's orders

• Purchase /Rent Price

• Color of the DME

• Weight of the DME

How much time does it take for a claim to be reprocessed?

• 30 - 45 business days

• 15 days

• 90 days

• 2 hours

Commercial group Member says we should be processing claims as secondary

• Yell at member

• Email ba_membersupport so that we can send a COB letter to member

• Email a COB letter yourself to member

• Convince member that we should be the primary

What to do with a commercial group COBRA call ?

• Transfer to Jessica Brungdart

• Request call back from ba_membersupport

• Hang up and go for some coffee

• Transfer to 90 Degrees