Appeal a Prior Authorization Denial *
Initiate and process the appeal of a previously denied authorization (pre-certification) request on behalf of the member for whom the service was requested.
The Authorization intake case type is used to receive and process authorization requests from providers. This case is specific to provider services.
Claims Inquiry *
Respond to claims-related questions by using information such as claim status, out-of-pocket costs, and service history. The case type creates the follow-up work that is needed based on the context of the interaction.
Collaborate in real time with a customer through sharing a browser session and providing guidance on how to navigate a website. The co-browse case maintains a history of the co-browse session, including a recording of the session (when the co-browsing recording feature is enabled) that can be viewed as part of the customer history.
Coordination of Benefits *
Collect policy information when members are covered by multiple plans. This coordinates benefit coverage and improves claims accuracy.
|Manage Appointment||A case type for canceling appointments or rescheduling appointments for a different time or with a different provider.|
|Medical Appointment Scheduling||A case type for scheduling new appointments. Schedulers and other representatives can schedule new appointments for different medical services while interacting with the patients or with an authorized contact on the patient's behalf.|
Negotiate a retention offer with a customer. This case type enables you to bundle multiple products together to create a custom retention offer and provide guidance to stay within a set budget for each offer.
|Request Prior Authorization|
A decision that is made by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. This case enables your physician to obtain approval from your health insurance plan for treatment. A prior authorization is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company.
CSRs can facilitate interactions between customers and sales representatives by scheduling appointments on behalf of the sales representative. CSRs can view available appointment times on the Microsoft Outlook calendars of the sales representatives.
Select and present cross-sell and other offers to a customer.
Update Contact Profile
Update contact profile information, such as first, middle, and last name, date of birth, verification settings, such as social security number and security questions, and marketing preferences.
Update or correct a provider’s National Provider Identifier (NPI) number.
Update Practitioner Address *
Submit a request to update practitioner addresses.
Update Hospital Admitting Privileges
Update the list of hospitals at which a practitioner holds admitting privileges.
Update Practitioner Business Affiliations
Update a practitioner's relationship with the business entities (hospitals and clinics) with which they are associated.
Update Practitioner Languages
Update the languages that are spoken by a practitioner.
Update Practitioner Licenses
Update the license-related information that is held by a practitioner, such as a state-issued medical licenses, Drug Enforcement Administration (DEA) number, and Medicare and Medicaid numbers.
Update Practitioner Specialties
Update the type of provider and the specialties that are recorded for the practitioner.
Review the member’s plan and product eligibility information, including information on specific benefit coverage.