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WorksheetsG&A and CDHP Recap
Total questions: 20
Worksheet time: 11mins
also known as a formal dissatisfaction
(a)
This is a type of spending account that is optional for the employer to give a physical card. Funds are debited automatically from the account.
HSA
EPO
HRA
LPFSA
This is when a member or provider does not agree with our decision and wants us to take another look to change the outcome.
Appeal
Grievance
Complaint
CA DMHC
They are known as our "Invisible vendor" also known as Tier 2, they are our spending account experts.
Alegeus
Pegasus
AIM
CDHP
This is a Type of Spending Account that is Prefunded by the employer, if the member leaves the employer they do not get to keep the funds.
HSA
FSA
HRA
HSA
This is a type of spending account in which the member contribues to each pay period and acts as a spending account. If the member decides to leave the company they get to keep the funds
LPFSA
HSA
HRA
EPO
A member was in an auto accident and calls to check the paid claim being the other persons insurance should be be paying. where should we transfer this member.
We handle that call in member services
Claims
UM
Subrogation
After a member files an appeal how will they be notified by the outcome
By Email 5-7 business days after the determination is made
A Rep from the appeals team will call the member back when its finished being processed
By letter 5-7 business days after the determination is made
By a phone call 5-7 business days after the determination is made
This Part of Medicare covers Labs and x rays along with DME
A
B
C
D
This is a type of spending account that limits purchases to only Vision and Dental
HSA
HRA
Limited Purpose FSA
Dependent Care Account
This is our department that handles issues revolving payments for accidents such as motor vehicle accidents.
Appeals Department
Subrogation
Claims Department
UM
Members can file a Grievance or Appeal by going to their web portal
True
False
This Part of Medicare offers optional Pharmacy
A
B
C
D
This is the system we can access to view more details about a members spending account. This system can also be accessed inside Solution Central
WNS
WCA
CIRS
XTRA
This is a type of Grievance that is unique to CA 200C policies and must be captured during the call
One Day Grievance
Standard Grievance
CA Appeal
CA DMHC
A CDHP is paired with what kind of plan
ISG Policies
Low Deductible Plans
Large Group Plans
High Deductible Plans
What part of Medicare pays for inpatient Hospital stays
A
B
C
D
When a member has more than one insurance provider they can pick and choose who they want to act as primary
True
False
When it comes to updating a members COB..
We simply update the members COB in Limited Liability
We Inform the member it will take 30 Business days and set a PA
We simply gather the necessary info and submit the request to our COB Team
Gather the required information from the member and update in Limited Liability
Under what circumstances can a member become eligible for Medicare
Is Disabled
65 Years or older
Has End Stage Renal Disease
Purchase it through Medicare directly
