Appeal Process Flashcard

Appeal Process Flashcard

Assessment

Flashcard

English

12th Grade

Hard

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15 questions

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1.

FLASHCARD QUESTION

Front

What is the correct email address for the G&A team when sending additional information or a member's request to cancel?

Back

GNABCC@anthem.com

2.

FLASHCARD QUESTION

Front

What must be obtained when completing a verbal DOR?

Back

HIPPA Verification

3.

FLASHCARD QUESTION

Front

If a member's claim has been denied as not medically necessary, what type of request is this?

Back

Appeal

4.

FLASHCARD QUESTION

Front

What is the purpose of verbal authorization according to the document?

Back

To ensure all interactions are completed from end to end

5.

FLASHCARD QUESTION

Front

What must be documented in the 'who' box for a verbal DOR?

Back

Name and relationship of the caller

6.

FLASHCARD QUESTION

Front

What is a verbal DOR?

Back

A verbal Document of Record (DOR) is a process to document verbal communications regarding member requests.

7.

FLASHCARD QUESTION

Front

What is the difference between a grievance and an appeal?

Back

A grievance is a complaint about the service or treatment, while an appeal is a request to review a denied claim.

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