The Missing Link

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Across
  1. 3. - Where can members find doctors in their area/in our network? Hint: Website
  2. 4. What is the name of Anthems preferred pharmacy vendor? Hint: Not Walgreens.
  3. 6. - What button do you use in CSA to pull up the members information after you have gathered what you needed from the member? Hint: Grey toolbar at top of phone inquiry screen.
  4. 8. - What is code V5030 for? Hint: Ear Supply
  5. 9. - What is the recommended id number that providers can give to you in order to find them quickly? Hint: National Number.
  6. 11. What is one of the preferred labs used by Anthem? Hint: Facility.
  7. 14. - What Protection Benefit covers certain Member out-of-pocket costs for covered medical expenses above a certain limit? Hint: SBP (Service Benefit Plan)
  8. 16. - What type of representative can act as a member? Hint: Not an Authorized Rep.
  9. 18. - What tab do you use in member 360 to quote copays and information regarding benefits to the member? Hint: Left hand side of member 360.
  10. 20. - What insurance does FEP not coordinate with? Hint: This insurance falls under the category for an exception to timely filing.
Down
  1. 1. - What is the fixed amount of money paid to the provider called? Hint: Not coinsurance.
  2. 2. - What is determined by providers before a procedure is done? Hint: You have to make sure the procedure does not require this before moving forward.
  3. 5. What is it called when we file a claim on December 31 of the year after the date of service? Hint: Timely Filing
  4. 7. - What is the fixed amount of covered expenses that the member must incur for certain covered services and supplies before we start paying benefits for them? Hint: Copays and Coinsurance do not count towards this.
  5. 8. - What do we need to gather from members/providers before we can release personal information? Hint: Protection of Health Information
  6. 10. - What system do you use to determine if a provider status is active and in our network? Hint: You can also find the Anthem provider number using this sytem.
  7. 12. - What is used to document telephone, walk in, web, and written inquiries? Hint: You have to use this system every day.
  8. 13. - What is the negotiated maximum allowable charge that preferred dentist's agree to accept as payment in full? HINT: Oral evaluation
  9. 15. - What system do we use when Member 360 is down? Hint: FEP System
  10. 17. - What is used to change your system status? Hint: Genesys.
  11. 19. - How many ID cards are you allowed to send a member per their request? Hint: Requests