Training

HealthCare Overview:

o HealthCare Eco System primarily involves: Insurance/Payer, Hospital/Provider and

Subscriber/Member
o Overview of Member Enrollment, Provider Network, Claims, Billing
o Plan Details – Copayment, Co-insurance, Deductible, OOP Max,

Benefit Plan:

o Fee for Service / Capitation

o High Deductible Plans
o Managed Care
o HMO (Provider Network), PPO, POS, EPO
o Prescription Drugs

Benefit Plan Setup: (P2A Template Updates)

Plan (HMO, PPO) and Plan Year (Calendar Year /Plan Year)

Cost Sharing Details:

o Annual Member Deductible

o Family Deductible
o Annual Member Out of Pocket Maximum
o Annual Family Out of Pocket Maxim

Services:

o Physician Office Visits

o Inpatient Services
o Outpatient Services
o Outpatient Lab and Surgery
o Emergency
o Ambulance
o Psychiatric
o Drug/Alcohol use
P2A Overview:

Product Plan Management

o Standard Plans Generated and Managed used by BDA (Benefit Document

Administration)
o Custom Plans Created from paperwork

Media Management

 Templates
o Templates are updated before Filling
o Templates are updated after Objection received
 Batches
o Standard Documents are Generated
 Documents
o Custom SBC and BB generated
o Standard documents are distributed

Workflow

o Filling
o Objection Management

Drafting and Filling:

See Versions of Previous Filling Templates to understand the recent changes, etc

Generate real time documents both SBC and BB