a provider (doctor's office) calls on behalf of the member, what should you ask them to identify:
provider's name and NPI number/If they are calling from the office/Their first name and last initial/Their call back number/Member's FULL NAME/DOB/NON PUBLIC EL
ACH is a paper check. TRUE OR FALSE
FALSE
a Mother of minor member who is 14 calls into inquire about his behavioral health coverage. Can you give her this specific info?
A minor aged 14-17 is required to authorize a parent to speak about behavioral health.
You are speaking with a confirmed auth rep on a members acct. Can you assist with a PCP change?
An auth rep CANNOT make changes but we can release information to them.
Members must stay within GHP network. Name an exception allowed for members going out of GHP network
The only exception to going out-of-network is in the case of an emergency room visit.
What company/vendor helps us match up patients with DME vendors that have the item they are looking for
Tomorrow Health
When verifying a caller you find they have an individual named in the address field indicating they are in the care of another person.The member is under 18. Can they make changes like a PCP change
YES The individual can make changes, like a PCP change
Grandmom is calling in for her Grandson(18)wants to know what Doctor we have on file.How do you handle this request?What questions should we ask?
Her first and last name/her call back #/Members first and last name/DOB/ 1 NON PUBLIC Element/Is member avail to give verbal consent?/
Give 3 examples of a NON PUBLIC element
Name of members PCP/ Member ID#/Date of a previous doctor appts/last 4 digits of SSN/Medical Record Number
Give 3 examples of PUBLIC DATA
NAME/DOB/PHONE NUMBER#/ADDRESS/EMAIL ADDRESS
Wife is calling in for her member husband- she just wants to know if his Prior Auth has been received from the provider office.You may give her the update. True or False
False : Member is an adult, this is protected health info
What 3 catergories fall under behavioral health ?
Mental Health/ Substance abuse/ Family Planning
