MPS Marketplace Global MSR New Hire Training: 4-Week Final Exam-Review

Claims (medical, vision, dental, and behavioral health) are in one Amisys environment called “Marketplace PROD".

Subscriber needs status of 2 claims. 1 for herself, & 1 for a 4-yr-old dependent. Which OMNI Task is used, and how many?

When claims show as “REJECTED” in the OMNI Member Composite Claims tab, how does the agent view the rejection reasons?

Member calls about her adult son's premium. She is not an authorized caller. Which 3 pieces of info can be given to her?

A member's written or verbal request to overturn an adverse decision (i.e., denied claim or authorization) is called:

Based on this OMNI claim image, the member owes a cost-sharing amount.

The information in this image must be read to the caller verbatim when providing eligibility information.

A member's current PCP is Meredith Grey, M.D. Member wants to switch to Gregory House, M.D. Which OMNI Intent is used?

A member's claim was denied. Using the OMNI Claim image, which tab is used to view explanation codes (EX Codes)?

A 12-year-old from Washington calls to get benefit info. The caller is HIPAA verified. How should the agent proceed?

Each year, the Health Insurance Marketplace (HIM) holds Open Enrollment from:

A member is having difficulty navigating his secure web portal. Agents may assist the caller using this site.

This tab in the OMNI Member Composite shows interactions, service items, historical call notes, & member events.

This Amisys Run Screen shows all adjudicated claims for a specific member.

Review the disclaimer in this OMNI image. In which Intent does this disclaimer appear?

When viewing the member’s account, the active enrollment span shows VAD in the product details. What does VAD indicate?

A member requests a replacement My Health Pays card. Which OMNI Intent is used?

This sub-tab of the Portico Network tab shows the participation status for a specific provider, location, and date.

You've completed web portal support. You must take this action in Support-a-User to properly leave the member's account.

In the Practitioners tab of Portico, which sub-tab houses the practitioner’s Hat Code and Taxonomy Codes?

Upon locating a member’s record in Support-a-User, select this option to assist the caller:

A member asks if Adderall is covered. What state-specific, website-based resource will the agent use to find this info?

A member received a bill. The medical claim is not on file in OMNI. The agent will now search for the claim in _____.

Member asks what his family has met towards their In-network Maximum Out-of-Pocket. From the image, what is the amount?

These THREE enrollment statuses apply to active members, regardless of premium payment status:

Caller’s claim was denied for no authorization. At a minimum, which TWO OMNI Intents should be opened?

After discussing details of a claim, the caller agrees with the status. Which option should we select from the dropdown?

Using the Member Tab in the OMNI Member Composite, in which section is authorized contact information located?

Member asks when the next payment is due on his account. The account shows paid thru 08/31/22. When is his premium due?

To view My Health Pays rewards, member transactions, and balances, an agent may access OMNI or: