A decision about payment for care is called a post service appeal and must be resolved no later than 70 calendar days after the appeal is received. True or false
True
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15
If a post service appeal form is submitted outside of this period of time then when it will be administratively
Denied
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eraser
Reset score!
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gold
Win 50 points!
Okay!
gift
Win 10 points!
Okay!
baam
Lose 10 points!
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25
If a provider is calling to make an appeal , you must
Transfer the call to provider services line
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seesaw
Swap points!
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fairy
Take points!
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fairy
Take points!
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baam
Lose 20 points!
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20
A post service appeal may be submitted by
The member / someone with written autorization to take actions on behalf the member
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seesaw
Swap points!
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rocket
Go to first place!
Okay!
fairy
Take points!
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thief
Give points!
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25
In case of a provider disputing payment/denial , what we should do?
We should follow the dispute process
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25
A member reach out complaining about the service he got at his local hospital , clover member service support should
Do a grievance
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15
In order to get a post service appeals a member needs to send a formal letter to clover. True or false
True
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15
A post service appeal should include at least : _______ ( mention 5 elements )
Name , address, phone number , member id number , claim number , DOS, provider information , what is being appealed , reasons , evidence, completed WOL
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20
The post service appeal can be sent only via email , True or false
False
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15
If one of our members decides to send a post service appeal , it should be sent to
