Letters

Front

What should you do if a claim is not on file while reviewing multiple claims?

Back

Open a second Manage claims task to document the claim not on file.

Front

Can you send letters from Create Correspondence during an active call?

Back

False

Front

What are the 4 ODG Letters?

Back

1. Contact CoveredCA 2. Missing claim or Need More Info 3. Prior Auth Missing information 4. Contact Employer Group

Front

What is needed to complete an exempt grievance task if a member's Prior auth hasn't processed due to missing medical records?

Back

Send the required letter.

Front

What must you do if a member calls looking for a claim that is not on file?

Back

Send the required letter.

Front

What is the purpose of the 'Contact Provider' letter?

Back

To communicate with the provider regarding a specific claim or issue.

Front

What does the 'Claim has processed' letter indicate?

Back

It informs the member that their claim has been processed.

Front

What does the 'Prior Auth Denied' letter signify?

Back

It indicates that the prior authorization request has been denied.

Front

What is the function of the 'Contact Enrollment and Billing' letter?

Back

To address issues related to enrollment and billing for members.

Front

What should be documented if a claim is not found during a member's inquiry?

Back

Document the details of the inquiry and the fact that the claim is not on file.