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START

QUIZ ABOUT

Grievance and Claims

Grievance Error- Filing Grievance

Advise Grv will be filed verbally

A

Document and file under any mbr account

B

Prior to submitting a Grv in compass it is best to review member details and documentation.

C

D

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GOODLUCK!

File on C30

Grievance Error- Mbr sts provider submitted PA but it is not in cup, what steps do we follow?

Tell mbr we will wait and see if we receive PA

A

Tell mbr to go see PCP

B

Wish them Luck!

C

Follow up with provider while mbr is on call and/or submit the request in Cup

D

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GOODLUCK!

Grievance Error- What Grievances does MS not handle?

Transportation

A

Dental

B

Vision

C

Pharmacy

D

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GOODLUCK!

Grievance Error- caller is not the mbr and no AOR/POA

Grv filed as Resolved

A

Grv filed as Unresolved

B

Grv filed as Resolved "one and done"

C

Grv filed Resolved no POA or AOR and no mbr verbal consent

D

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GOODLUCK!

Lorem ipsum dolor sit amet, consectetuer adipiscing elit sed diam nonummy?

Wrong answer

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Lorem ipsum dolor sit amet, consectetuer adipiscing elit sed diam nonummy?

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WRONG!

Lorem ipsum dolor sit amet, consectetuer adipiscing elit sed diam nonummy?

Wrong answer

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Right answer

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Lorem ipsum dolor sit amet, consectetuer adipiscing elit sed diam nonummy?

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Lorem ipsum dolor sit amet, consectetuer adipiscing elit sed diam nonummy?

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D

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WRONG!

YOU WIN!

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WELL DONE!

BACK