ODG Quiz

What are the 4 ODG Letters?

• We do not have to send letters

• -Contact Provider

  -Contact PMG

  -Contact Covered CA

  -Missing Information on a Claim

• -Contact Employer Group

  -Contact Covered CA

  -Missing Claim or Missing information on a Claim

  -Missing information on Authorization

• If we resolve the request the letter does not have to be sent.

What Company Code applies to the California DMHC One Day Grievance Process?

• 200C

• 360C

• 368C

• 858C

What steps must be followed when a member is advised that their claim is not on file?

Select all that apply

• Send applicable ODG Letter

• Advise member to call provider and have them send the claim to us.

• Reach out to provider or facility to request the resubmission of claim.

• Transfer the caller to another rep to see if they have the information available.

What steps must be followed if a provider list is sent to the member?

Select all that apply

• Create Provider Task in SC

• Answer ODG Questions by selecting Provider not found/Emailed Directory

• Attach list to SC

• Go to Anthem.com directly to avoid opening the task in SC

What required step must be followed if a member calls and needs Interpretation Services?

• Ask the member if they would like to update their preferred written or spoken language.

• Transfer the member to the designated language line

• Determine if the type of issue really needs an interpreter.

• Transfer member to your supervisor for help.

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What must be done if you are trying to complete an interaction and a system issue prevents closure of your One Day Grievance?

• Close the work item and leave on dashboard, it will close itself overnight

• Cancel the work that is preventing you from completing your call.

• Reach out to support chat to receive assistance in closing the item same day

• Ignore it, the system will handle the issue.

How must the ODG be documented if a member calls about a past interaction or grievance?

• Tag the prior Interaction or Grievance within the ODG

• Transfer the call to the previous associate and log your interaction as an inquiry

• Select the Repeat Contact Indicator and link the prior interaction to yours

• Document the ODG as an Inquiry because there is no current problem only a previous one.

What is the correct process to research and/or quote benefits for a member?

• Benefits and Cost Task

• EOC Link instead of using SC

• Ask your OE

• Tag the benefits that have been qouted

What should be the correct selection ODG Dissatisfaction when routing a service to another area for review? i.e. Claims Adjustments, Accumulator Review and COB updates.

• Referred to Internal Department

• Educated Contact

• Updated Database

• Single Case Agreement

If the Authorization in question is missing information. What steps must be completed?

Select all that apply

• Select the Authorization to answer ODG questions

• Issue ODG letter Prior Auth Missing Information

• Cancel the task and advise member to have provider send us the needed info

• Contact provider for the needed information on behalf of member