Module 4: Wrap-Up

Match the description of the system with it's name.

• APTC

• A system that can be used to access eligibility information if it isn't displayed in ACE.

• Provider Inquiry

• Personally Identifiable Information

• MPUI

• This retail policy type would allow a 3-month, calendar month grace period and assistance with paying premiums.

• PII

• This system can be used to identify more information about a provider located in one of our 5 states within HCSC

• QHP

• A retail plan that was created after the passing of the ACA

True or False: The Blue Cross Blue Shield Association spans across all 50 states including two territories.

• False

• True

Starting from the beginning, put the steps in order on how to locate the PTD for a QHP Retail Policy.

• If the information does not populate, enter the member number to search for that policy

• From related links, launch RPI by using the search bar. Single-left click on RPI

• Identify, in ACE, that the policy is QHP Retail

Match the inquiry type under the correct column.

Groups:

(a) Eligibility Inquires

,

(b) Benefit Inquires

,

(c) Claim Inquires

• How much has this patient/member met on their OPX?

• What is the copay for an office visit?

• I want to file an appeal for the denial of this claim, how would I do that?

• What date did the claim process?

• Why did this claim deny?

• Does an MRI need a pre-auth?

• What is the group number associated with this policy.

• Is this patient/member on the policy?

• What is the effective date of this policy?

True or False: We do, as a company, offer an option for international coverage and that is called GEO Blue.

• False

• True

​ ​ ​ (a)   is the plan where the insurance is housed, the​ (b)   is where the Provider is housed.

• Home Plan
• Host Plan
• HCSC
• In-Network
• Out-of-Network
• BCBSA

Why would you need to research in COB Solutions?

• If claims are denying.

• If the policy is a retail policy.

• Every time you get a call.

• When/if a Provider asks if the patient/member has another insurance

What system would you need to look up the PTD for a Legacy policy.

(a)  

What is an NPI number?

• A unique, 10-digit number required by HIPAA, to identify themselves in admin and financial transactions.

• It is the member number located on their insurance card.

• An internal number used for classification by HCSC. Also known as PFIN

• A number used in conjunction with the member number known as the group number.

What card, in ACE, can you launch COB Solutions?

(a)