What happens if an appeal is received without the required form or the verbal DOR process isn't completed/correctly documented?
Appeal Process Flashcard

Flashcard
•
English
•
12th Grade
•
Hard
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1.
FLASHCARD QUESTION
Front
Back
The appeal may be closed.
2.
FLASHCARD QUESTION
Front
What must be documented in the 'who' box for a verbal DOR?
Back
Name and relationship of the caller.
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 expected of member services when a member wants to appeal?
Back
Fully explain the appeal process to the member and assist politely.
5.
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.
6.
FLASHCARD QUESTION
Front
Define 'Appeal' in the context of member services.
Back
A formal request for reconsideration of a decision made regarding a claim.
7.
FLASHCARD QUESTION
Front
What is a 'Grievance' in member services?
Back
A complaint about the quality of care or service received.
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