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Thank you for requesting information about the Premera


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Thank you for requesting information about the Premera FEP IVR (Interactive Voice Response) system. Our IVR provides you with eligibility and claim status information and selected benefits.


Please note the following:


  • To protect personal information (PPI), all IVR callers must go through the caller verification process before receiving information. Callers are verified based on information available on our local system so it is possible that some out-of-state callers may not be able to use the IVR.

  • Eligibility, claim status and our top 10 benefits are available 24 hours a day EXCEPT for Sunday mornings from 4:00 AM – 9:00 AM Eastern Time and during scheduled outages for system maintenance.

  • IVR quotes the 10 benefits requested most often from Customer Service.

For your convenience, the following worksheets are available for use when using IVR. The worksheets are set-up in the order that information is presented during the call.1


S

CLAIM STATUS


ELIGIBILITY




Enter the Subscriber ID #:

R     

Patient’s date of birth:

     




Eligibility Effective Date:

Plan Name2

Policy Covers2

Enrollment Code2

Grace Period?3

     

Standard Option

Basic Option



Subscriber only

Subscriber & Family



104

105


111

112


     



Standard Option: Both Preferred and Non-preferred providers can be used, however, out-of-pocket expenses are lower when Preferred providers are used. Standard Option has a calendar year deductible for some services and a $20 copayment for office visits to Preferred primary care providers ($30 for specialists).

Basic Option Basic Option does not have a calendar year deductible. Most services are subject to copayments ($25 for primary care providers and $35 for specialists). Members do not need to have referrals to see specialists. Preferred providers must be used to be eligible for benefits, except in certain circumstances, such as emergency care.


BENEFIT




Benefit Quote

What benefit do you want2:


Facility In Patient Stay

Facility OP Medical

Facility OP Surgery

Prof Office Visit

Prof Chiropractic


Prof PT/OT/ST

Prof Preventive Care

Prof Surgery

Prof Diagnostic

Other from Cust. Svc


What is your contracting status2:

Preferred

Participating

Non-Participating


FEP is2:

Copay Amount:4

Individual Deductible Amount:4

Individual Deductible Met to date:4

Primary

Secondary to Commercial

Secondary to Medicare


$     

$     

$     

Family Calendar Year Deductible Amount4

Family Calendar Year Deductible Met to date4

% Plan Pays of Plan Allowance4

Additional information4

$     

$     

     %

     

Out of Pocket Maximum2

Out of Pocket Maximum Met to date

Comments:      

$5000.00

$7000.00



$     

Chiro4services allowed: 1 office visit, 1 set of x-rays and manipulations: 12 for Standard Option/20 for Basic Option

PT/ST/OT Visits5

BO = 50 allowed5

SO = 75 allowed


Used:      


Chiro3Used:

Visits:

     


X-rays:

     


Manipulations:

     

CLAIM STATUS



Patient Name: ________________________________ Date: ___________


Enter the Subscriber ID #:

R     

Patient’s date of birth:      




1st Claim

Claim #

Total Charge

DOS

Received Date 6

Paid Date

Claim Payment Amount

     

$     

     

     

     

$      

Paid to (provider/subscriber)

Patient’s Liability

Provider Write-off7

Check Number

Bulk Check Amount

Check Cleared Date

     

$     

$     

     

$     

     

Comments:      





















Enter the Subscriber ID #:

R     

Patient’s date of birth:      




2nd Claim

Claim #

Total Charge

DOS

Received Date 6

Paid Date

Claim Payment Amount

     

$     

     

     

     

$      

Paid to (provider/subscriber)

Patient’s Liability

Provider Write-off7

Check Number

Bulk Check Amount

Check Cleared Date

     

$     

$     

     

$     

     

Comments:      




















Enter the Subscriber ID #:

R     

Patient’s date of birth:      




3rd Claim

Claim #

Total Charge

DOS

Received Date 6

Paid Date

Claim Payment Amount

     

$     

     

     

     

$      

Paid to (provider/subscriber)

Patient’s Liability

Provider Write-off7

Check Number

Bulk Check Amount

Check Cleared Date

     

$     

$     

     

$     

     

Comments:      




FEP SPEECH RECOGNITION IVR JOB AID





Function

Say

Keypad Option

Enter the IVR

Provider

2

ID number

R00000000

None (must be spoken)

Date of birth

April 4, 2006 or 4/4/2006

04042006 (8 digits)

Reply “yes”

Yes

1

Reply “no”

No

2

To hear eligibility

Eligibility

1

To hear benefits8

Benefits

2

Claim status

Claim Status

3

Care Management

Care Management

4

Next member/patient

Next patient

#

Main menu

Main menu

*

Benefit Commands:







Participating provider

Participating

1

Non-Participating provider

Non-Participating

2

Next benefit phrase




#

Facility Inpatient Stay

Facility Inpatient Stay, Inpatient stay, admit

9

Facility Outpatient Surgery

Facility Outpatient Surgery

7

Facility Outpatient Medical

Facility Outpatient Medical

8

Professional Office Visit

Professional Office Visit

1

Professional Preventive Care

Professional Preventive Care, Preventive care, annual exam, annual physical

2

Professional Diagnostic

Professional Diagnostic, diagnostic, lab, x-ray

3

Professional Physical, Speech, Occupational Therapy

Professional Physical Therapy, Professional Speech Therapy, Professional Occupational Therapy, Professional PT

4

Professional Chiropractic

Professional Chiropractic, chiropractic, chiro, spinal manipulations

5

Professional Surgical

Professional Surgical, professional surgery

6

Claim Status Commands:







Search for claims by specific date

Date

1

Search for claims by month and year

Month

2

Date of Service

April 4, 2006 or

4/4/2006


04042006

(8 digits)



Next claim

Next claim

#

FEP SPEECH RECOGNITION IVR DETAILS




  1. Eligibility, Benefits and Claim Status are options available to FEP providers (FEP members are offered eligibility and benefits only)

  2. Since Claim Status information is only offered to providers, you must use the provider option (#2) when entering the IVR

  3. Due to HIPAA regulations, all callers must be verified.

    • It is important to remember that you can hear only the claims that were submitted under the tax ID number with which you verify

    • If you use more than one TIN to submit claims, you need to redial the IVR and re-verify with the other TIN before hearing claims submitted under those numbers

  4. This is a speech recognition system, but it also supports the use of the telephone keypad to perform tasks such as entering the tax ID number and dates and to reply yes (#1) or no (#2) to questions

  5. You MUST speak the member’s Subscriber ID number beginning with the letter “R” e.g. R12345678 (cannot use the keypad and cannot omit the letter R)

  6. Dates can be stated as April 4, 2010 or 4/4/2010 or entered using the keypad as an eight digit number (8 digits) 04042010, but dates are not recognized if a 2 digit year is spoken or typed, e.g. spoken 4/4/10 or typed 4410

  7. The system offers a “barge-in” feature that allows you to move quickly through the menus

    • It is not necessary to wait for the menu option to finish before making a choice

    • A whole phrase is not required, for example, the IVR will ask if you want to search for claims by specific date or a range of dates. It will prompt you to say “specific date” or “month and year of service”. Simply say “date” or “month” (be sure to include the whole year, 2005 not 05, when prompted for the date)

  8. Because the claims database is so large, we want to verify that we have the date(s) correct before doing a search so the IVR will always ask for verification of the date before searching. A search by month will always speak the date range for a whole month, e.g. September 1, 2010 – September 30, 2010, even if you are calling on September 15th

  9. If the search returns three or fewer claims, all three claims will be quoted (see exception in #12 below)

  10. If more than three claims are found, you will be asked if you want to narrow the search by total charge

  11. If the claim was denied and then paid, only the most recent iteration of the claim is spoken

  12. If there are multiple denials or multiple paid claims for the same date, all claims are spoken

  13. Once the IVR begins quoting a series of claims, say “next claim” or press the pound key (#) at any time to move on to the next claim

  14. If the IVR cannot find a claim with the exact total charge, it will search for the claim that most closely matches the request

  15. Eligibility is always quoted before a benefit is spoken, so whether you say “eligibility” or “benefits”, the quote will start with eligibility

  16. Currently, nine (9) benefits are quoted (speak the benefit name or use the numeric equivalent from the job aid). Three facility benefits (claims will be billed on a UB04) and nine professional benefits (claims will be billed on a HCFA1500) :

    • Facility Inpatient Stay

    • Facility Outpatient Medical

    • Facility Outpatient Surgical

    • Professional Office Visit

    • Professional Diagnostic

    • Professional Preventive Care (both Adult and Child benefits are quoted, but you do not need to say adult/child because the IVR will compute the patient’s age then quote the correct benefit based on the age)

    • Professional Physical, Speech and Occupational Therapy (no need to say all three, just say professional speech therapy or professional PT, etc.)

    • Professional Chiropractic

    • Professional Surgery




1 Except for Chiropractic and PT/OT/ST benefit limits; these are found at the end of the form.

2 Check one

3 Under some circumstances, terminated members may have a 31 day grace period. If a grace period applies to your patient, the IVR will advise you.

5 BO = Basic Option (50 visits allowed) & SO = Standard Option (75 visits allowed)

6 Received date is heard only on claims in process or denied, but the received date is NOT heard on paid claims

7 If applicable

8 Note that eligibility is always quoted before a benefit quote, so whether you say “eligibility” or “benefits” first, eligibility will be quoted.

017805 (11-2012)




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