WorksheetsJAA Quick Test
Total questions: 15
Worksheet time: 9mins
We use the Employer Contract Number when checking JAA information
True
False
Caller says they are INN. I should
Take their word for it
Check CA Mainframe
Check Findcare
Check Network Information
As this is a self-funded policy, we are not granted the permission from the employer group to inquire about member requested materials, such as accident reports, COB updates, etc. as this is between the member and member services.
Once the member has returned the requested information, the employer group will adjust affected claims. If claims have not yet been adjusted, the member will need to communicate this to their member services.
When do we say this?
When asking for COB
When asking for Eligibility
When asking for Accumulations
If group is Wellpath
These amounts may change through processing of new claims or adjustment of previously processed claims.
We say this when quoting
Benefit Information
Coordination of Benefits
Precertification
Accumulations
We use the following when checking Benefit Information...
NLS
NLS - Legacy
FOBS
EOC
NIC JAA
These are the things I need to provide when quoting Eligibility
Policy Status
Effective Date
Benefit Period
Contract Type
What do we do when the group is on Do Not Call?
Refer to VRU
Refer to OE/SME
PACB
Call any number in the Update page
What are the things we need to have when checking JAA In Scope Indicators?
Update Pages
UM Profile Pages
Workflows
JAA WGS Master List
What does this tell you?
AIM is purchased and may be referred to CMBM
Precertification is being handled via their TPA
Precertification is handled by UM
AIM is not purchased, and needs to reserch further.
If claim is past the Claims Run-out Date, I should...
Send the claim back to the TPA
Refer the caller to their local
Refer the caller to coordinate with member
If Precertification is not required for a medical procedure, I should...
Check Aspen for Predetermination
Check OMPTA for Predetermination
Procedure does not require review
Procedure needs to be determined by the TPA
It is advisable to download whatever file available in the JAA Sharepoint site
True
False
I'm checking for Participating Status for a PPO policy. I should look in the network information for
Any PPO
any BLUE EPO
any BLUE PPO
any BLUE HMO
For the most part, checking for precertification is code-based
True
False
JAA does not follow X guidelines.
(a)
