Centene Final Midterm Exam Questions With Complete Solutions Graded A+

Centene Final Midterm Exam Questions With Complete Solutions Graded A+ How many HIPAA items must be verified when speaking with a prospective member? 0 Where can you locate rejected Pharmacy Claims if they are not displaying in Omni? CVS/COS You can use the following systems to verify member eligibility, except? Portico If a member calls to update their address and it has not been updated in MARx, we should? Submit the address change request and direct the member to contact the SSA to update the address with them. True or False: When making permanent address update we should inform the member to also contact Social Security Administration to update their address with them. True Which Omni intent would you use when if a member calls in to ask how much of their deductible has been met? Accumulator Inquiry Which Omni intent will you use to verify if a care Manager / Case Manager is assigned to a member? Care management What am I? '' I received a call from my case manager telling me that my procedure was denied because of insufficient of some sort. my doctor recommended this surgery, should that be enough to approve it?'m Appeal What are the two main uses for the TruCloud? select two case management and Authorizations In Amisys, we can view all EXCEPT Authorized representatives When a caller is requesting to speak on behalf of a member, a C SR can get ________ _________ from the member. The 2 HIPAA verifiers must be provided by the _________, not the caller. Verbal authorization/ member In Omni the intent/tasks that are used to update demographics (address,name,DOB) require the user to first access _________ system to verify what information it has. MARx When a member has other insurance besides Centene's, this is referred to as: OHI or COB ___________ Grievances require a written response but __________ Grievances are handled by the CSR AND USUALLY resolved within first call.