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WorksheetsLast Week
Total questions: 20
Worksheet time: 10mins
the 4 lines of business are IGO, IBO, ASO, PPO
True
False
What drives the benefit
DOS
POS
Plan that you are enrolled in
Coinsurance/Deductible/ Copays
To send and EOB from Facets which program do we use
Magic
Mobius
PPU
Webnow
Facets and Webnow are a couple
True
False
Which tab from the Csp home page allows you to search the prefix fro a blue member that may NOT be a blue NC member
Blue Cross Blue Shield Association
Custom Group Summary
Network Management
Individual Membership
The two plans that we do not service are State Health & Provider
True
False
If the policy is active but has a future term date, advise the caller that a certificate of coverage will be generated automatically upon termination of the policy.
True
False
Service 1st reads:
Top to bottom
Left to right
Click any applet you click
None of the above
In Mobius we will search for the Id by subscriber number using what number
ECN
DCN
SSN
Prefix of the member ID
In case of ER/Urgent Care one should follow these steps:
Seek help/ care immediate from an ER or similar facility
Call the Police
Call 911
If unsure whether a condition is an emergency, call HealthLine Blue
Emergency room and Urgent Care claims are processed as
OON
INN
Specialty Services
Ancillary
01-052902-250-48 is a what type of claim
manuall entered claim
Local Claim
was entered in Power MHS in 2002
is an adjusted claim
Adjudication means:
kick back and reprocess
to study and settle
is paid and reconciled
a denied claim
If a Member calls in and doesn't have an ID or card yet, we are able to look up by their SSN in what place/places
Magic
Service 1st
Power MHS
Care Radius
CTRL + O is used in Facets to do:
A quick claim Inquiry
Select 2 claims and run simultaneously
Validate Hippa Screen
Search for groups of ID when you don't have a member id
Can a Blue NC member services be covered by Blue NC if they go out of state.
YES
NO
Accidental dental is a benefit available to all members regardless of age.
True
False
The following categories of benefits are covered under pediatric dental :
Diagnostic and Preventive Services
Basic and Major Services
Orthodontia Services
An ASO reserves the right to customize it's employees insurance plans, some reasons may be:
because the ASO is exempt fro the NCDOI
they are fully funded
they are self funded
they pockets run deep and they can
when using a DCN it is made up of what 2 sets of numbers:
claim rec'd date + CID minus the 5th digit
ECN + EDI
Members internal and external id number minus the 5th digit
9107771859
