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 company code applies to the DMHC Process?

Back

200C

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 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 the purpose of documenting claims not on file?

Back

To ensure accurate record-keeping and follow-up on unresolved claims.

Front

What is the significance of the company code in the DMHC Process?

Back

It identifies the specific procedures and regulations applicable to that company.

Front

Why is it important to send the required letter when a claim is not found?

Back

To inform the member of the status and next steps regarding their claim.

Front

What does 'Create Correspondence' refer to in a claims process?

Back

It is a function that allows communication with members regarding their claims.

Front

What does the term 'exempt grievance task' mean?

Back

A task related to grievances that do not require standard processing due to specific exemptions.