WorksheetsBenefit management
Total questions: 12
Worksheet time: 4mins
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
Which option from your mini menu do you use to check if a DPC referral is on file?
Grace Period Not Defined For Group
Select By Status Range
Select By Log Type
Select By Patient ID
Who can take BMI901 calls?
A) Laci M.,
B) Amanda N., .
C) Hilary C
D) All of the above
