It is a bill that members and providers receive from UHC to be paid.
B.
A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.
C.
A request to send a check to the members in order to cover their medical services including prescription.
D.
A bill that is send to the member in order to let them know about the copayment that they have to pay for medical services and prescription coverage.
2.
What is the tool that advocates can use to send an explanation of benefits to the member?
A.
VIEW
B.
KNOWLEDGE CENTRAL
C.
DOC360
D.
ICUE
3.
What is a delegated claim?
A.
UnitedHealthCare process member's claims, and send an EOB to members and providers.
B.
Claims are processed by Medicare and Medicaid. UnitedHealthCare does not cover member's services
C.
It is a process where PMG, Medicare, and Medicaid cover part C and pert D in behalf of the member.
D.
It is a formal process where UnitedHealthcare gives a contracting Medical Group/Provider the responsibility and authority to perform specific functions like claims processing
4.
If a member is calling from WV to check a claim for dental services, what is the process that advocates have to follow?
A.
Advocates open the account - open review claim history - look for the date of service - advise the member about their copayment.
B.
Advocate open the account - open review claim history - look for the date of service - open review medical claims to confirm member's copay - advise the member about their responsibility (Copay)
C.
Advocate open the account - ask for the date of service - ask to the member about other inquiry - confirm that member has dental benefits - warm transfer to Dental department.
D.
Advocate do not open the account - advise the member that call to dental department - disconnect the call.
5.
How long does it take to process a claim if the provider is PAR?
A.
90 business days
B.
30 business days
C.
90 calendar days
D.
30 - 60 calendar days
6.
If a claim is PENDING, what does it mean?
A.
Claim is pending because provider needs to send additional information
B.
Claim was processed but the provider did not receive the payment.
C.
Claim, it is being reviewed to resolve some discrepancy
D.
Claim was already paid but the member needs to pay the copayment
