For Claim Inquiry, the following can be used to verify except for one, which is it?

Member’s full address, DOB, last 4 digits of the SSN, or phone number can also be used to verify information when a provider is unable to accurately verify the member’s name or ID.

If a provider asks about another claim for a different member, the provider must verify at least how many data points?

How many data points should be asked for it to be HIPAA Validated?

If a provider is not in the system, but they can verify HIPAA for the member, information can't be provided.

What is the "Greeting" order sequence?

The following are greeting requirements, except for what?

Whenever the caller would ask your full name, you should provide it directly.

What is the Transperfect Number?

What is the Language Service that helps us in interpreting?

How many seconds is the maximum threshold for hard hold?

How many seconds is the maximum threshold for soft hold?

How many seconds is the maximum threshold for dead air?

How many seconds is the maximum threshold for a caller to put us on hold?

What is the correct sequence for answering a call?

When did Healthfirst first established?

A nationally recognized trade organization servicing the medical community of physicians

An organization within the United States Department of Health and Human Services that administers the Medicare program and certain aspects of state Medicaid programs

Department of Social Services that administers a broad range of social welfare programs and services New York City

Claim resubmitted to correct original claim on file

Claim inquiry not found in systems

Service dates for member on claims

A member’s ID number with HF

Coding system(Service Codes) used for reporting medical services (5 digits)

Coding system primarily used by Hospitals(3 digits)

Equipment used by patient, primarily to serve amedical purpose(prosthetics, wheelchairs, dressings)

Type of pricing method used to price an Inpatient Hospital Claim

Claims submitted by providers or facilities electronically

Summary of processed payments or claims(providers usually refer to this also as EOB)

Regarding patients who are not self-sufficient

Referred as Authorization Department or Intake Department.

Summary of processed payments or claims(providers usually refer to this also as EOB).

A department where providers are being transferred after the claim is validated and claims are being reprocessed real time.

Refers to a percentage of payment or a set dollar amount deducted from the provider contractual payment or reimbursement.

It is a “fixed” amount of money paid in advance to the physician for delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided.

Payment made to providers based on a specific visit or procedure

The monthly payment a member must make to keep their health insurance plan active. To activate one’s health plan, a member must make an initial payment called a binder payment.

A percentage of the cost for health care service paid by a member after they have met or reached their annual deductible. (A member may pay all medical costs until reaching their deductible. After that, member pay only copays and/or coinsurance for covered services.

A flat fee a member must pay for doctor visits or prescriptions

The most a member will have to pay out of his/her own pocket each year for medical services

The yearly out-of-pocket amount a member must pay before their plan will pay for covered services

Number assigned to providers by the state placed on claims

ID # assigned to providers by HF

Set of codes used to identify condition, symptoms, disorders, diseases, etc…for seen patient

A participating provider who has been selected by or otherwise assigned to a member to provide Primary Care Covered Services required by the member and who is responsible for coordinating all referral covered services