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["Caller  Type","Category","Business Owner","Detail","Error Code",null,"1 Digit Each",null,null,"2 Digits"]
["1 - Member - Claim","A- Advanced Radiology","A - Advocate- Errors for the Advocate team","01-Advanced Radiology Imaging information is provided inaccurately","AA01",null,"01 - 09","A - Y","A - V","01 - 99"]
["2 - Member - Benefit","A- Advanced Radiology","A - Advocate- Errors for the Advocate team","02-Advanced Radiology Imaging information is provided incompletely","AA02",null,"Call Type","Category","Business Owner","Detail"]
["3 - Member - Eligibility","A- Advanced Radiology","A - Advocate- Errors for the Advocate team","03-Pre certification/pre determination/referral information is provided inaccurately","AA03",null,"Example: 1AA01"]
["4 - Member - Other","A- Advanced Radiology","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","01-Pre certification/pre determination/referral information is provided inaccurately","AO01"]
["5 - HCP - Claim","A- Advanced Radiology","A - Advocate- Errors for the Advocate team","04-Pre certification/pre determination/referral information is provided incompletely","AA04"]
["6 - HCP - Benefit","A- Advanced Radiology","A - Advocate- Errors for the Advocate team","05-The Advocate did not follow the process for ARI inquiries found in the Advanced Radiology Imaging Call Handling or the Advanced Radiology Imaging ARI Health Care Professional Call Handling","AA05"]
["7 - HCP - Eligibility","A- Advanced Radiology","A - Advocate- Errors for the Advocate team","06-The Advocate did not perform a warm transfer to the ARI team","AA06"]
["8 - HCP - Other","B - Advocacy","A - Advocate- Errors for the Advocate team","01-The Advocate did not make the customer feel their issue is important","BA01"]
["9 - Other - All","B - Advocacy","A - Advocate- Errors for the Advocate team","02-The Advocate did not serve as a consultant by suggesting options to customers and providing context when appropriate. (e.g. suggesting cheaper solution for medical supplies)","BA02"]
[null,"B - Advocacy","A - Advocate- Errors for the Advocate team","03-The Advocate  did not educate or mention to the customer on self-service options or tools available (myCigna.com, mobile application)","BA03"]
[null,"B - Advocacy","A - Advocate- Errors for the Advocate team","04-The Advocate did not educate the customer on how to resolve their  issue","BA04"]
[null,"B - Advocacy","M- Appeal Unit – Responsible for researching and approving appeals.","01-The Advocate did not educate the customer on how to resolve their  issue","BM01"]
[null,"B - Advocacy","A - Advocate- Errors for the Advocate team","05-The Advocate failed to be the Advocate for the caller","BA05"]
[null,"C - Appeals","A - Advocate- Errors for the Advocate team","01-Appeal information is provided inaccurately","CA01"]
[null,"C - Appeals","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-Appeal information is provided inaccurately","CC01"]
[null,"C - Appeals","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Appeal information is provided inaccurately","CE01"]
[null,"C - Appeals","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-Appeal information is provided inaccurately","CH01"]
[null,"C - Appeals","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Appeal information is provided inaccurately","CN01"]
[null,"C - Appeals","M- Appeal Unit – Responsible for researching and approving appeals.","01-Appeal information is provided inaccurately","CM01"]
[null,"C - Appeals","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01Appeal information is provided inaccurately","CP01"]
[null,"C - Appeals","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-Appeal information is provided inaccurately","CS01"]
[null,"C - Appeals","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01Appeal information is provided inaccurately","CV01"]
[null,"C - Appeals","A - Advocate- Errors for the Advocate team","02-Appeal information is provided incompletely","CA02"]
[null,"C - Appeals","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-Appeal information is provided incompletely","CC02"]
[null,"C - Appeals","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Appeal information is provided incompletely","CE02"]
[null,"C - Appeals","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-Appeal information is provided incompletely","CH02"]
[null,"C - Appeals","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Appeal information is provided incompletely","CN02"]
[null,"C - Appeals","M- Appeal Unit – Responsible for researching and approving appeals.","02-Appeal information is provided incompletely","CMO2"]
[null,"C - Appeals","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-Appeal information is provided incompletely","CPO2"]
[null,"C - Appeals","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-Appeal information is provided incompletely","CS02"]
[null,"C - Appeals","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-Appeal information is provided incompletely","CV02"]
[null,"C - Appeals","A - Advocate- Errors for the Advocate team","03-Time frame-Appeal time frame provided inaccurately","CA03"]
[null,"C - Appeals","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","03-Time frame-Appeal time frame provided inaccurately","CC03"]
[null,"C - Appeals","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03-Time frame-Appeal time frame provided inaccurately","CE03"]
[null,"C - Appeals","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","03-Time frame-Appeal time frame provided inaccurately","CH03"]
[null,"C - Appeals","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","03-Time frame-Appeal time frame provided inaccurately","CNO3"]
[null,"C - Appeals","M- Appeal Unit – Responsible for researching and approving appeals.","03-Time frame-Appeal time frame provided inaccurately","CMO3"]
[null,"C - Appeals","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","03-Time frame-Appeal time frame provided inaccurately","CPO3"]
[null,"C - Appeals","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","03-Time frame-Appeal time frame provided inaccurately","CSO3"]
[null,"C - Appeals","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","03-Time frame-Appeal time frame provided inaccurately","CV03"]
[null,"C - Appeals","A - Advocate- Errors for the Advocate team","04-Time frame-Appeal time frame provided incompletely","CA04"]
[null,"C - Appeals","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","04-Time frame-Appeal time frame provided incompletely","CC04"]
[null,"C - Appeals","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04-Time frame-Appeal time frame provided incompletely","CE04"]
[null,"C - Appeals","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","04-Time frame-Appeal time frame provided incompletely","CH04"]
[null,"C - Appeals","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","04-Time frame-Appeal time frame provided incompletely","CNO4"]
[null,"C - Appeals","M- Appeal Unit – Responsible for researching and approving appeals.","04-Time frame-Appeal time frame provided incompletely","CMO4"]
[null,"C - Appeals","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","04-Time frame-Appeal time frame provided incompletely","CPO4"]
[null,"C - Appeals","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","04-Time frame-Appeal time frame provided incompletely","CSO4"]
[null,"C - Appeals","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","04-Time frame-Appeal time frame provided incompletely","CV04"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","01-Benefit-Age limitation is provided inaccurately","DA01"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Benefit-Age limitation is provided inaccurately","DE01"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","02-Benefit-Age limitation is provided incompletely","DA02"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Benefit-Age limitation is provided incompletely","DE02"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","03-Benefit-Co-pay/Coinsurance/deductible/OOP information is provided inaccurately","DA03"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03-Benefit-Co-pay/Coinsurance/deductible/OOP information is provided inaccurately","DE03"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","04- Benefit-Co-pay/Coinsurance/deductible/OOP information is provided incompletely ","DA04"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04- Benefit-Co-pay/Coinsurance/deductible/OOP information is provided incompletely ","DE04"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","05- Benefit-Full mouth, panoramic, and/or bitewing x-ray information is provided inaccurately ","DA05"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","05- Benefit-Full mouth, panoramic, and/or bitewing x-ray information is provided inaccurately ","DE05"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","06-Benefit-Full mouth, panoramic, and/or bitewing x-ray information is provided incompletely ","DA06"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 06-Benefit-Full mouth, panoramic, and/or bitewing x-ray information is provided incompletely ","DE06"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 07-Benefit-Information quoted as covered for a non-covered service ","DA07"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 08-Benefit-Information quoted as not covered for a covered service ","DA08"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 09-Benefit-Information regarding frequencies is provided inaccurately ","DA09"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 07-Benefit-Information regarding frequencies is provided inaccurately ","DE07"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 10-Benefit-Information regarding frequencies is provided incompletely ","DA10"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 08-Benefit-Information regarding frequencies is provided incompletely ","DE08"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 11-Benefit-Limits/maximums/provision information is provided inaccurately ","DA11"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 09-Benefit-Limits/maximums/provision information is provided inaccurately ","DE09"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 12-Benefit-Limits/maximums/provision information is provided incompletely ","DA12"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 10-Benefit-Limits/maximums/provision information is provided incompletely ","DE10"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 13-Benefit-Maternity benefit information is provided inaccurately ","DA13"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 11-Benefit-Maternity benefit information is provided inaccurately ","DE11"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 14-Benefit-Maternity benefit information is provided incompletely ","DA14"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 12-Benefit-Maternity benefit information is provided incompletely ","DE12"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 15-Benefit-Missing tooth limitation/clause is provided inaccurately ","DA15"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 13-Benefit-Missing tooth limitation/clause is provided inaccurately ","DE13"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 16-Benefit-Missing tooth limitation/clause is provided incompletely ","DA16"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 14-Benefit-Missing tooth limitation/clause is provided incompletely ","DE14"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 17-Benefit-Oral Surgery benefits are provided inaccurately ","DA17"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 15-Benefit-Oral Surgery benefits are provided inaccurately ","DE15"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 18-Benefit-Oral Surgery benefits are provided incompletely ","DA18"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 16-Benefit-Oral Surgery benefits are provided incompletely ","DE16"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 19-Benefit-Orthodontic information is provided inaccurately ","DA19"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 17-Benefit-Orthodontic information is provided inaccurately ","DE17"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 20-Benefit-Orthodontic information is provided incompletely ","DA20"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 18-Benefit-Orthodontic information is provided incompletely ","DE18"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 21-Benefit-Other-Benefit information is provided inaccurately ","DA21"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 19-Benefit-Other-Benefit information is provided inaccurately ","DE19"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 22-Benefit-Other-Benefit information is provided incompletely ","DA22"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 20-Benefit-Other-Benefit information is provided incompletely ","DE20"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 23-Benefit-Periodontal information is provided inaccurately ","DA23"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 21-Benefit-Periodontal information is provided inaccurately ","DE21"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 24-Benefit-Periodontal information is provided incompletely ","DA24"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 22-Benefit-Periodontal information is provided incompletely ","DE22"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 25-Benefit-Plan type information is provided inaccurately ","DA25"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 23-Benefit-Plan type information is provided inaccurately ","DE23"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 26-Benefit-Plan type information is provided incompletely ","DA26"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 24-Benefit-Plan type information is provided incompletely ","DE24"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 27-Benefit-Sealant information is provided inaccurately ","DA27"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 25-Benefit-Sealant information is provided inaccurately ","DE25"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 28-Benefit-Sealant information is provided incompletely ","DA28"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 26-Benefit-Sealant information is provided incompletely ","DE26"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 29-Benefits-Pharmacy benefits are provided inaccurately ","DA29"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 27-Benefits-Pharmacy benefits are provided inaccurately ","DE27"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 30-Benefits-Pharmacy benefits are provided incompletely ","DA30"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 28-Benefits-Pharmacy benefits are provided incompletely ","DE28"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 31-Benefit-The alternate benefit information is provided inaccurately ","DA31"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 29-Benefit-The alternate benefit information is provided inaccurately ","DE29"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 32-Benefit-The alternate benefit information is provided incompletely ","DA32"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 30-Benefit-The alternate benefit information is provided incompletely ","DE30"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 33-Benefit-The Advocate did not advise that the benefit is subject to medical necessity/review ","DA33"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 31-Benefit-The Advocate did not advise that the benefit is subject to medical necessity/review ","DE31"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 34-Benefit-The incorrect benefit is quoted for type or place of service ","DA34"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 32-Benefit-The incorrect benefit is quoted for type or place of service ","DE32"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 35-Benefit-Therapy (speech, physical, occupational, chiropractic, etc.) information is provided inaccurately ","DA35"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 33-Benefit-Therapy (speech, physical, occupational, chiropractic, etc.) information is provided inaccurately ","DE33"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 36-Benefit-Therapy (speech, physical, occupational, chiropractic, etc.) information is provided incompletely ","DA36"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 34-Benefit-Therapy (speech, physical, occupational, chiropractic, etc.) information is provided incompletely ","DE34"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 37-Benefit-Vision information is provided inaccurately ","DA37"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 35-Benefit-Vision information is provided inaccurately ","DE35"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 38-Benefit-Vision information is provided incompletely ","DA38"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 36-Benefit-Vision information is provided incompletely ","DE36"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 39-Benefit-Well care/preventive care information is provided inaccurately ","DA39"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 37-Benefit-Well care/preventive care information is provided inaccurately ","DE37"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 40-Benefit-Well care/preventive care information is provided incompletely ","DA40"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 38-Benefit-Well care/preventive care information is provided incompletely ","DE38"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team"," 41-Benefit-When quoting in network benefits to a customer the Advocate did not explain coverage is based on the contracted rate ","DA41"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 39-Benefit-When quoting in network benefits to a customer the Advocate did not explain coverage is based on the contracted rate ","DE39"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","42-Benefit-When quoting out of network benefits the Advocate did not tell the caller that coverage is based on the Maximum Reimbursable Charge (MRC/ACR/U&C/RNC)","DA42"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","40-Benefit-When quoting out of network benefits the Advocate did not tell the caller that coverage is based on the Maximum Reimbursable Charge (MRC/ACR/U&C/RNC)","DE40"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","43-Benefit-HSA/FSA/HRA information is provided inaccurately","DA43"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","41-Benefit-HSA/FSA/HRA information is provided inaccurately","DE41"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","44-Benefit-HSA/FSA/HRA information is provided incompletely","DA44"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","42-Benefit-HSA/FSA/HRA information is provided incompletely","DE42"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","45-Benefit-Pre-existing/waiting period information is provided inaccurately","DA45"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","43-Benefit-Pre-existing/waiting period information is provided inaccurately","DE43"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","46-Benefit-Pre-existing/waiting period information is provided incompletely","DA46"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","44-Benefit-Pre-existing/waiting period information is provided incompletely","DE44"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","47-The Advocate fails to offer to provide the specific benefits, in addition to validating the status of the Health Care Professional (HCP) ","DA47"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","45-The Advocate fails to offer to provide the specific benefits, in addition to validating the status of the Health Care Professional (HCP) ","DE45"]
[null,"D - Benefits","A - Advocate- Errors for the Advocate team","48-The Advocate did not verify the status of the Health Care Professional (HCP) in addition to providing the specific benefits","DA48"]
[null,"D - Benefits","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","46-The Advocate did not verify the status of the Health Care Professional (HCP) in addition to providing the specific benefits","DE46"]
[null,"E - Call Back","A - Advocate- Errors for the Advocate team","01-The Advocate did not take full ownership and use the appropriate actions to resolve the caller’s request","EA01"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","01-Advocate fails to obtain phone number","FA01"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","FA02 not to be used at this time","FA02"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","03-Accurate Documentation- Additional coding should have been utilized.   ","FA03"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","04-Accurate Documentation- Incomplete/inaccurate information is documented. ","FA04"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","05-Accurate Documentation- The caller's name and that he/she gave permission to speak with another person was not documented. ","FA05"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","06-Accurate Documentation- The Advocate did not create another request/task in addition to the system generated: HIPAA Validated ","FA06"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","07-Accurate Documentation- The Advocate did not document that permission was obtained to leave a voicemail when an open call exists ","FA07"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","08-Accurate Documentation- The correct caller name, healthcare professional/facility name, TIN, NABP, and or relationship code is not obtained and/or documented ","FA08"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","09-Accurate Documentation- The caller's name shows as “Null” or is blank in OneView. Please ensure you are documenting the name of the caller and clicking on “save”  ","FA09"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","10-Accurate Documentation- The open call is misrouted ","FA10"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","11-Accurate Documentation- Method of contact-The method of contact is not documented appropriately ","FA11"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","12-Accurate Documentation- The inquiry is not documented.","FA12"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","13-Accurate Documentation-The call was documented as “Dropped Calls/Call Tracking Needed”; however additional comments were not added to address what the call was about ","FA13"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","14-Accurate Documentation- Follow-up indicator-There was no indication in the documentation that follow up was promised ","FA14"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","15-Accurate Documentation- Correct ID/File-Documentation is under the incorrect ID number, line of eligibility, or patient file. Please refer to the Call Documentation SOP ","FA15"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","16-Accurate Documentation- Coding-The correct coding is not utilized.  Please refer to the Call Documentation SOP, and/or Request/Task Documentation Call Job Aid ","FA16"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","FA17 not to be used at this time","FA17"]
[null,"F - Call Documentation","A - Advocate- Errors for the Advocate team","FA18 not to be used at this time","FA18"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","01-The Advocate does not sound confident when speaking with customer ","GA01"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","02-The Advocate does not have a natural call flow ","GA02"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-The Advocate does not have a natural call flow ","GS01"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","03-The Advocate engages in small talk with customer that does not use the information to help resolve issue ","GA03"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","04-The Advocate allows the caller to steer the conversation in a way that could have been avoided","GA04"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","05-The Advocate allows the caller to control the call","GA05"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","06-The Advocate sounds scripted ","GA06"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-The Advocate sounds scripted ","GS02"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","07-The Advocate does not utilize programs and tools available to assist the customer properly","GA07"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","01-The Advocate does not utilize programs and tools available to assist the customer properly","GM01"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","03-The Advocate does not utilize programs and tools available to assist the customer properly","GS03"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","08-The Advocate does not utilize their OneView “Shortcut Keys” to efficiently manage the call","GA08"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","04-The Advocate does not utilize their OneView “Shortcut Keys” to efficiently manage the call","GS04"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","09-The Advocate uses an overly casual tone ","GA09"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","GA10 not to be used at this time","GA10"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","11-The Advocate frequently jumps to conclusions, “best guesses” and provided answers based on assumptions","GA11"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","02-The Advocate frequently jumps to conclusions, “best guesses” and provided answers based on assumptions","GM02"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","12-Call Management-The caller experienced extensive and/or multiple periods of dead air","GA12"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-Call Management-The caller experienced extensive and/or multiple periods of dead air","GC01"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Call Management-The caller experienced extensive and/or multiple periods of dead air","GE01"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-Call Management-The caller experienced extensive and/or multiple periods of dead air","GH01"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Call Management-The caller experienced extensive and/or multiple periods of dead air","GN01"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","03-Call Management-The caller experienced extensive and/or multiple periods of dead air","GM03"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-Call Management-The caller experienced extensive and/or multiple periods of dead air","GP01"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","05-Call Management-The caller experienced extensive and/or multiple periods of dead air","GS05"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-Call Management-The caller experienced extensive and/or multiple periods of dead air","GV01"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","13-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GA13"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GC02"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GE02"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GH02"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GN02"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","04-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GM04"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GP02"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","06-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GS06"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-Call Management-The caller experienced extensive hold times without the Advocate checking back with their caller after 2 minutes","GV02"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","14-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GA14"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","03-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GC03"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GE03"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","03-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GH03"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","03-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GN03"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","05-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GM05"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","03-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GP03"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","07-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GS07"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","03-Call Management-The caller was placed on hold multiple times without the Advocate checking back with their caller after 2 minutes","GV03"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","15-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GA15"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","04-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GC04"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GE04"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","04-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GH04"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","04-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GN04"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","06-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GM06"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","04-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GP04"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","08-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GS08"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","04-Call Management-The Advocate does not ask for and receive permission prior to placing the caller on hold","GV04"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","16-Call Management-The Advocate does not explain the reason for “dead air” ","GA16"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","05-Call Management-The Advocate does not explain the reason for “dead air” ","GC05"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","05-Call Management-The Advocate does not explain the reason for “dead air” ","GE05"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","05-Call Management-The Advocate does not explain the reason for “dead air” ","GH05"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","05-Call Management-The Advocate does not explain the reason for “dead air” ","GN05"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","07-Call Management-The Advocate does not explain the reason for “dead air” ","GM07"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","05-Call Management-The Advocate does not explain the reason for “dead air” ","GP05"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","09-Call Management-The Advocate does not explain the reason for “dead air” ","GS09"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","05-Call Management-The Advocate does not explain the reason for “dead air” ","GV05"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","17-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GA17"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","06-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GC06"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","06-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GE06"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","06-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GH06"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","06-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GN06"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","08-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GM08"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","06-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GPO06"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","10-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GS10"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","06-Call Management-The Advocate does not thank the caller for holding when removing the caller from hold","GV06"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","18-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GA18"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","07-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GC07"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","07-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GE07"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","07-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GH07"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","07-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GN07"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","09-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GM09"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","07-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GP07"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","11-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GS11"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","07-Call Management-When the caller is placed on hold, you did not check back with the caller every two minutes. Please see the Greeting, Caller Verification, and Closing SOP  ","GV07"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","19-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GA19"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","08-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GC08"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","08-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GE08"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","08-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GH08"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","08-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GN08"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","10-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GM10"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","08-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GP08"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","12-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GS12"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","08-Call Management-The appropriate steps are not followed to defuse an angry/upset caller. Please refer to the Defusing Anger - Escalated Calls SOP","GV08"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","20-Call Management-The caller is interrupted when speaking","GA20"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","09-Call Management-The caller is interrupted when speaking","GC09"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","09-Call Management-The caller is interrupted when speaking","GE09"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","09-Call Management-The caller is interrupted when speaking","GH09"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","09-Call Management-The caller is interrupted when speaking","GN09"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","11-Call Management-The caller is interrupted when speaking","GM11"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","09-Call Management-The caller is interrupted when speaking","GP09"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","13-Call Management-The caller is interrupted when speaking","GS13"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","09-Call Management-The caller is interrupted when speaking","GV09"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","21-Call Management-The caller is rushed through the call","GA21"]
[null,"G - Call Management","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","10-Call Management-The caller is rushed through the call","GC10"]
[null,"G - Call Management","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","10-Call Management-The caller is rushed through the call","GE10"]
[null,"G - Call Management","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","10-Call Management-The caller is rushed through the call","GH10"]
[null,"G - Call Management","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","10-Call Management-The caller is rushed through the call","GN10"]
[null,"G - Call Management","M- Appeal Unit – Responsible for researching and approving appeals.","12-Call Management-The caller is rushed through the call","GM12"]
[null,"G - Call Management","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","10-Call Management-The caller is rushed through the call","GP10"]
[null,"G - Call Management","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","14-Call Management-The caller is rushed through the call","GS14"]
[null,"G - Call Management","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","10-Call Management-The caller is rushed through the call","GV10"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","22-The Advocate did not use active listening skills ","GA22"]
[null,"G - Call Management","A - Advocate- Errors for the Advocate team","23 - The Advocate did not use the customer last name at least twice  during the call or did not ask customer to use first name","GA23"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-The Advocate fails to identify best practice resolution for common/simple claim issues ","HC01"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-The Advocate fails to identify best practice resolution for common/simple claim issues ","HS01"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","01-The Advocate fails to identify best practice resolution for common/simple claim issues ","HA01"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-The Advocate fails to identify best practice resolution for complex claim issues ","HC02"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-The Advocate fails to identify best practice resolution for complex claim issues ","HS02"]
["5 - HCP - Claim","H - Claims","A - Advocate- Errors for the Advocate team","02-The Advocate fails to identify best practice resolution for complex claim issues ","HA02"]
["6 - HCP - Benefit","H - Claims","A - Advocate- Errors for the Advocate team","03-The Advocate but fails to consider how personal attributes can impact customer interactions ","HA03"]
["7 - HCP - Eligibility","H - Claims","A - Advocate- Errors for the Advocate team","04-The Advocate did not incorporate personality flexing into customer interactions","HA04"]
["8 - HCP – Other","H - Claims","A - Advocate- Errors for the Advocate team","05-The Advocate does not recognize the customer’s tone and inflection during the call","HA05"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  03-Claim, Denial - Additional information needed to process the claim is provided inaccurately  ","HC03"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  01-Claim, Denial - Additional information needed to process the claim is provided inaccurately  ","HE01"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  01-Claim, Denial - Additional information needed to process the claim is provided inaccurately  ","HH01"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  01-Claim, Denial - Additional information needed to process the claim is provided inaccurately  ","HN01"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 06-Claims, Denial- Additional information needed to process the claim is provided inaccurately  ","HA06"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  04-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HC04"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  02-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HE02"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  02-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HH02"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  02-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HN02"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  01-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HP01"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  01-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HV01"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  07-Claim, Denial -Additional information needed to process the claim is provided incompletely  ","HA07"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  05-Claims, Denial - Check payment and/or status is provided inaccurately  ","HC05"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  08-Claims, Denial - Check payment and/or status is provided inaccurately  ","HA08"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  06-Claims, Denial - Check payment and/or status is provided incompletely  ","HC06"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  03-Claims, Denial - Check payment and/or status is provided incompletely  ","HS03"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  09-Claims, Denial - Check payment and/or status is provided incompletely  ","HA09"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  07-Claims, Denial - Other claim information is provided inaccurately  ","HC07"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  10-Claims, Denial - Other claim information is provided inaccurately  ","HA10"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  08-Claims, Denial - Other claim information is provided incompletely  ","HC08"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  11-Claims, Denial - Other claim information is provided incompletely  ","HA11"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  09-Claims, Denial - Processing status is provided inaccurately   ","HC09"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  12-Claims, Denial - Processing status is provided inaccurately   ","HA12"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  10-Claims, Denial - Processing status is provided incompletely  ","HC10"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  13-Claims, Denial - Processing status is provided incompletely  ","HA13"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  11-Claims, Denial - The Advocate incorrectly advises the claim is not on file  ","HC11"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  04-Claims, Denial - The Advocate incorrectly advises the claim is not on file  ","HS04"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  14-Claims, Denial - The Advocate incorrectly advises the claim is not on file  ","HA14"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  12-Claims, Denial - The patient liability is provided inaccurately  ","HC12"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  03-Claims, Denial - The patient liability is provided inaccurately  ","HE03"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  03-Claims, Denial - The patient liability is provided inaccurately  ","HH03"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  03-Claims, Denial - The patient liability is provided inaccurately  ","HN03"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  02-Claims, Denial - The patient liability is provided inaccurately  ","HP02"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  02-Claims, Denial - The patient liability is provided inaccurately  ","HV02"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  15-Claims, Denial - The patient liability is provided inaccurately  ","HA15"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  13-Claims, Denial - The patient liability is provided incompletely  ","HC13"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  04-Claims, Denial - The patient liability is provided incompletely  ","HE04"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  04-Claims, Denial - The patient liability is provided incompletely  ","HH04"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  04-Claims, Denial - The patient liability is provided incompletely  ","HN04"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  03-Claims, Denial - The patient liability is provided incompletely  ","HP03"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  03-Claims, Denial - The patient liability is provided incompletely  ","HV03"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  16-Claims, Denial - The patient liability is provided incompletely  ","HA16"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 14-Claims, Denial - The Advocate did not follow the process for Same Day Adjustments","HC14"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 05-Claims, Denial - The Advocate did not follow the process for Same Day Adjustments","HS05"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 17-Claims, Denial - The Advocate did not follow the process for Same Day Adjustments","HA17"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 15-Claims, Denial - Time frame-Claim adjustment time frame is provided inaccurately","HC15"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 06-Claims, Denial - Time frame-Claim adjustment time frame is provided inaccurately","HS06"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 18-Claims, Denial - Time frame-Claim adjustment time frame is provided inaccurately","HA18"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 16-Claims, Denial - Time frame-Claim adjustment time frame is provided incompletely","HC16"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 07-Claims, Denial - Time frame-Claim adjustment time frame is provided incompletely","HS07"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 19-Claims, Denial - Time frame-Claim adjustment time frame is provided incompletely","HA19"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 17-Claims, Denial - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HC17"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 08-Claims, Denial - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HS08"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 20-Claims, Denial - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HA20"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  18-Claims, Ext Pend - Additional information needed to process the claim is provided inaccurately  ","HC18"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  21-Claims, Ext Pend - Additional information needed to process the claim is provided inaccurately  ","HA21"]
[null,"H - Claims","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible."," 01-Claims, Ext Pend - Additional information needed to process the claim is provided incompletely  ","HO01"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","22-Claims, Ext Pend - Additional information needed to process the claim is provided incompletely  ","HA22"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 23-Claims, Ext Pend - Check payment and/or status is provided inaccurately  ","HA23"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  19-Claims, Ext Pend - Check payment and/or status is provided incompletely  ","HC19"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  24-Claims, Ext Pend - Check payment and/or status is provided incompletely  ","HA24"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  20-Claims, Ext Pend - Other claim information is provided inaccurately  ","HC20"]
[null,"H - Claims","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","  02-Claims, Ext Pend - Other claim information is provided inaccurately  ","HO02"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  25-Claims, Ext Pend - Other claim information is provided inaccurately  ","HA25"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  21-Claims, Ext Pend - Other claim information is provided incompletely  ","HC21"]
[null,"H - Claims","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","  03-Claims, Ext Pend - Other claim information is provided incompletely  ","HO03"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  26-Claims, Ext Pend - Other claim information is provided incompletely  ","HA26"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  27-Claims, Ext Pend - Processing status is provided inaccurately   ","HA27"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  28-Claims, Ext Pend - Processing status is provided incompletely  ","HA28"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  22-Claims, Ext Pend - The Advocate incorrectly advises the claim is not on file  ","HC22"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  29-Claims, Ext Pend - The Advocate incorrectly advises the claim is not on file  ","HA29"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  23-Claims, Ext Pend - The patient liability is provided inaccurately  ","HC23"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  05-Claims, Ext Pend - The patient liability is provided inaccurately  ","HE05"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  05-Claims, Ext Pend - The patient liability is provided inaccurately  ","HH05"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  05-Claims, Ext Pend - The patient liability is provided inaccurately  ","HN05"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  04-Claims, Ext Pend - The patient liability is provided inaccurately  ","HP04"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  04-Claims, Ext Pend - The patient liability is provided inaccurately  ","HV04"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  30-Claims, Ext Pend - The patient liability is provided inaccurately  ","HA30"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  24-Claims, Ext Pend - The patient liability is provided incompletely  ","HC24"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  06-Claims, Ext Pend - The patient liability is provided incompletely  ","HE06"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  06-Claims, Ext Pend - The patient liability is provided incompletely  ","HH06"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  06-Claims, Ext Pend - The patient liability is provided incompletely  ","HN06"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  05-Claims, Ext Pend - The patient liability is provided incompletely  ","HP05"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  05-Claims, Ext Pend - The patient liability is provided incompletely  ","HV05"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  31-Claims, Ext Pend - The patient liability is provided incompletely  ","HA31"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 25-Claims, Ext Pend - The Advocate did not follow the process for Same Day Adjustments","HC25"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 09-Claims, Ext Pend - The Advocate did not follow the process for Same Day Adjustments","HS09"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 32-Claims, Ext Pend - The Advocate did not follow the process for Same Day Adjustments","HA32"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 26-Claims, Ext Pend - Time frame-Claim adjustment time frame is provided inaccurately","HC26"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 07-Claims, Ext Pend - Time frame-Claim adjustment time frame is provided inaccurately","HE07"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 10-Claims, Ext Pend - Time frame-Claim adjustment time frame is provided inaccurately","HS10"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 33-Claims, Ext Pend - Time frame-Claim adjustment time frame is provided inaccurately","HA33"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 08-Claims, Ext Pend - Time frame-Claim adjustment time frame is provided incompletely","HE08"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 34-Claims, Ext Pend - Time frame-Claim adjustment time frame is provided incompletely","HA34"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 27-Claims, Ext Pend - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HC27"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 35-Claims, Ext Pend - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HA35"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  28-Claims, Incorrect Payment - Additional information needed to process the claim is provided inaccurately  ","HC28"]
[null,"H - Claims","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","  04-Claims, Incorrect Payment - Additional information needed to process the claim is provided inaccurately  ","HO04"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 36-Claims, Incorrect Payment - Additional information needed to process the claim is provided inaccurately  ","HA36"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  29-Claims, Incorrect Payment - Additional information needed to process the claim is provided incompletely  ","HC29"]
[null,"H - Claims","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","  05-Claims, Incorrect Payment - Additional information needed to process the claim is provided incompletely  ","HO05"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 37-Claims, Incorrect Payment - Additional information needed to process the claim is provided incompletely  ","HA37"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  38-Claims, Incorrect Payment - Check payment and/or status is provided inaccurately  ","HA38"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  39-Claims, Incorrect Payment - Check payment and/or status is provided incompletely  ","HA39"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  30-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HC30"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  09-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HE09"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  07-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HH07"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  07-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HN07"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  06-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HP06"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  11-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HS11"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  06-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HV06"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  40-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HA40"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  31-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HC31"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  10-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HE10"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  08-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HH08"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  08-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HN08"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  07-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HP07"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  12-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HS12"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  07-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HV07"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  41-Claims, Incorrect Payment - Other claim information is provided incompletely  ","HA41"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  42-Claims, Incorrect Payment - Processing status is provided inaccurately   ","HA42"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  43-Claims, Incorrect Payment - Processing status is provided incompletely  ","HA43"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  44-Claims, Incorrect Payment - The Advocate incorrectly advises the claim is not on file  ","HA44"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  32-Claims, Incorrect Payment -The patient liability is provided inaccurately  ","HC32"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  45-Claims, Incorrect Payment -The patient liability is provided inaccurately  ","HA45"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  46-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HA46"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 11-Claims, Incorrect Payment - The Advocate did not follow the process for Same Day Adjustments","HE11"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate"," 13-Claims, Incorrect Payment - The Advocate did not follow the process for Same Day Adjustments","HS13"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 47-Claims, Incorrect Payment - The Advocate did not follow the process for Same Day Adjustments","HA47"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 33-Claims, Incorrect Payment - Time frame-Claim adjustment time frame is provided inaccurately","HC33"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 12-Claims, Incorrect Payment - Time frame-Claim adjustment time frame is provided inaccurately","HE12"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 48-Claims, Incorrect Payment - Time frame-Claim adjustment time frame is provided inaccurately","HA48"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 49-Claims, Incorrect Payment - Time frame-Claim adjustment time frame is provided incompletely","HA49"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 50-Claims, Incorrect Payment - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HA50"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  34-Claims, Incorrect Payment - Additional information needed to process the claim is provided inaccurately  ","HC34"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  51-Claims, Incorrect Payment - Additional information needed to process the claim is provided inaccurately  ","HA51"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  35-Claims, Incorrect Payment - Additional information needed to process the claim is provided incompletely  ","HC35"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  52-Claims, Incorrect Payment - Additional information needed to process the claim is provided incompletely  ","HA52"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  53-Claims, Incorrect Payment - Check payment and/or status is provided inaccurately  ","HA53"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  36-Claims, Incorrect Payment - Check payment and/or status is provided incompletely  ","HC36"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  54-Claims, Incorrect Payment - Check payment and/or status is provided incompletely  ","HA54"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  37-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HC37"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  55-Claims, Incorrect Payment - Other claim information is provided inaccurately  ","HA55"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  56-Claims, Incorrect Payment - Processing status is provided inaccurately   ","HA56"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  38-Claims, Incorrect Payment - Processing status is provided incompletely  ","HC38"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  57-Claims, Incorrect Payment - Processing status is provided incompletely  ","HA57"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  58-Claims, Incorrect Payment - The Advocate incorrectly advises the claim is not on file  ","HA58"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  39-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HC39"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  13-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HE13"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  09-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HH09"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  09-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HN09"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  08-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HP08"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  14-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HS14"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  08-Claims, Incorrect Payment - The patient liability is provided incompletely  ","HV08"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  59-Claims, Incorrect Payment -The patient liability is provided inaccurately  ","HA59"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 40-Claims, Incorrect Payment - The Advocate did not follow the process for Same Day Adjustments","HC40"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 60-Claims, Incorrect Payment - The Advocate did not follow the process for Same Day Adjustments","HA60"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 41-Claims, Incorrect Payment - Time frame-Claim adjustment time frame is provided inaccurately","HC41"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","HA61 not to be used at this time","HA61"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 42-Claims, Incorrect Payment - Time frame-Claim adjustment time frame is provided incompletely","HC42"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","HA62 not to be used at this time","HA62"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 63-Claims, Incorrect Payment - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HA63"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 43-Claims, Processing/Paid - Additional information needed to process the claim is provided inaccurately  ","HC43"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  64-Claims, Processing/Paid - Additional information needed to process the claim is provided inaccurately  ","HA64"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","65-Claims, Processing/Paid - Additional information needed to process the claim is provided incompletely  ","HA65"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 66-Claims, Processing/Paid - Check payment and/or status is provided inaccurately  ","HA66"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  67-Claims, Processing/Paid - Check payment and/or status is provided incompletely  ","HA67"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  44-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HC44"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  14-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HE14"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  10-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HH10"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  10-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HN10"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  09-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HP09"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  15-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HS15"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  09-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HV09"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  68-Claims, Processing/Paid - Other claim information is provided inaccurately  ","HA68"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  45-Claims, Processing/Paid - Other claim information is provided incompletely  ","HC45"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","  15-Claims, Processing/Paid - Other claim information is provided incompletely  ","HE15"]
[null,"H - Claims","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","  11-Claims, Processing/Paid - Other claim information is provided incompletely  ","HH11"]
[null,"H - Claims","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","  11-Claims, Processing/Paid - Other claim information is provided incompletely  ","HN11"]
[null,"H - Claims","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","  10-Claims, Processing/Paid - Other claim information is provided incompletely  ","HP10"]
[null,"H - Claims","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","  16-Claims, Processing/Paid - Other claim information is provided incompletely  ","HS16"]
[null,"H - Claims","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","  10-Claims, Processing/Paid - Other claim information is provided incompletely  ","HV10"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  69-Claims, Processing/Paid - Other claim information is provided incompletely  ","HA69"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  46-Claims, Processing/Paid - Processing status is provided inaccurately   ","HC46"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  70-Claims, Processing/Paid - Processing status is provided inaccurately   ","HA70"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  47-Claims, Processing/Paid - Processing status is provided incompletely  ","HC47"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  71-Claims, Processing/Paid - Processing status is provided incompletely  ","HA71"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  72-Claims, Processing/Paid - The Advocate incorrectly advises the claim is not on file  ","HA72"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  48-Claims, Processing/Paid - The patient liability is provided inaccurately  ","HC48"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  73-Claims, Processing/Paid - The patient liability is provided inaccurately  ","HA73"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","  49-Claims, Processing/Paid - The patient liability is provided incompletely  ","HC49"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  74-Claims, Processing/Paid - The patient liability is provided incompletely  ","HA74"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 75-Claims, Processing/Paid - The Advocate did not follow the process for Same Day Adjustments","HA75"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 50-Claims, Processing/Paid - Time frame-Claim adjustment time frame is provided inaccurately","HC50"]
[null,"H - Claims","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)"," 16-Claims, Processing/Paid - Time frame-Claim adjustment time frame is provided inaccurately","HE16"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 76-Claims, Processing/Paid - Time frame-Claim adjustment time frame is provided inaccurately","HA76"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 51-Claims, Processing/Paid - Time frame-Claim adjustment time frame is provided incompletely","HC51"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 77-Claims, Processing/Paid - Time frame-Claim adjustment time frame is provided incompletely","HA77"]
[null,"H - Claims","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures."," 52-Claims, Processing/Paid - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HC52"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 78-Claims, Processing/Paid - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HA78"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  79-Claims,Status - Additional information needed to process the claim is provided inaccurately  ","HA79"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  80-Claims,Status - Additional information needed to process the claim is provided incompletely  ","HA80"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","HA81 not to be used at this time","HA81"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","HA82 not to be used at this time","HA82"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  83-Claims,Status - Other claim information is provided inaccurately  ","HA83"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  84-Claims,Status - Other claim information is provided incompletely  ","HA84"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  85-Claims,Status - Processing status is provided inaccurately   ","HA85"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  86-Claims,Status - Processing status is provided incompletely  ","HA86"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  87-Claims,Status - The Advocate incorrectly advises the claim is not on file  ","HA87"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  88-Claims,Status - The patient liability is provided inaccurately  ","HA88"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team","  89-Claims,Status - The patient liability is provided incompletely  ","HA89"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 90-Claims,Status - The Advocate did not follow the process for Same Day Adjustments","HA90"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 91-Claims,Status - Time frame is provided inaccurately","HA91"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 92-Claims,Status - Time frame is provided incompletely","HA92"]
[null,"H - Claims","A - Advocate- Errors for the Advocate team"," 93-Claims,Status - The Advocate did not follow the process for Proclaim/PMHS Adjustment ","HA93"]
[null,"I - Closing","A - Advocate- Errors for the Advocate team","01-Closing-The Advocate does not utilize a professional closing  ","IA01"]
[null,"I - Closing","A - Advocate- Errors for the Advocate team","02-Closing-The Advocate does not ensure issue resolution was achieved  ","IA02"]
[null,"I - Closing","A - Advocate- Errors for the Advocate team","03-Closing-The Advocate did not brand Cigna at the close of the call  ","IA03"]
[null,"J - COB/Other Insurance","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Coordination of benefit (COB) information is provided inaccurately","JE01"]
[null,"J - COB/Other Insurance","A - Advocate- Errors for the Advocate team","01-Coordination of benefit (COB) information is provided inaccurately","JA01"]
[null,"J - COB/Other Insurance","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Coordination of benefit (COB) information is provided incompletely","JE02"]
[null,"J - COB/Other Insurance","A - Advocate- Errors for the Advocate team","02-Coordination of benefit (COB) information is provided incompletely","JA02"]
[null,"K - Effortless","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-Effortless-CIGNA Policy/Work flow-Advocate followed CIGNA guidelines","KC01"]
[null,"K - Effortless","M- Appeal Unit – Responsible for researching and approving appeals.","01-Effortless-CIGNA Policy/Work flow-Advocate followed CIGNA guidelines","KM01"]
[null,"K - Effortless","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-Effortless-CIGNA Policy/Work flow-Advocate followed CIGNA guidelines","KCS01"]
[null,"K - Effortless","A - Advocate- Errors for the Advocate team","01-Effortless-CIGNA Policy/Work flow-Advocate did not follow CIGNA guidelines","KA01"]
[null,"K - Effortless","A - Advocate- Errors for the Advocate team","02-Effortless-The Advocate did not advise the caller they may need to repeat the information already given, or by offering to perform a warm transfer","KA02"]
[null,"K - Effortless","A - Advocate- Errors for the Advocate team","03-Effortless-The Advocate does not take the effort off of the caller by taking a position of active support in their approach","KA03"]
[null,"K - Effortless","A - Advocate- Errors for the Advocate team","04-The Advocate did not do an outreach call  for the customer when they asked","KA04"]
[null,"K - Effortless","A - Advocate- Errors for the Advocate team","05-The Advocate did not ask key questions to gain understanding","KA05"]
[null,"K - Effortless","A - Advocate- Errors for the Advocate team","06-The Advocate fails to pick up customer cue(s) that could have resulted in complete issue resolution","KA06"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Eligibility information is provided inaccurately","LE01"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-Eligibility information is provided inaccurately","LH01"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Eligibility information is provided inaccurately","LN01"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","01-Eligibility information is provided inaccurately","LM01"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-Eligibility information is provided inaccurately","LP01"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-Eligibility information is provided inaccurately","LV01"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","01-Eligibility information is provided inaccurately","LA01"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Eligibility information is provided incompletely","LE02"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-Eligibility information is provided incompletely","LH02"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Eligibility information is provided incompletely","LN02"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","02-Eligibility information is provided incompletely","LM02"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-Eligibility information is provided incompletely","LP02"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-Eligibility information is provided incompletely","LV02"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","02-Eligibility information is provided incompletely","LA02"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03-Contract year is provided inaccurately","LE03"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","03-Contract year is provided inaccurately","LH03"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Contract year is provided inaccurately","LN02"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","03-Contract year is provided inaccurately","LM03"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","03-Contract year is provided inaccurately","LP03"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","03-Contract year is provided inaccurately","LV03"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","03-Contract year is provided inaccurately","LA03"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04-Contract year is provided incompletely","LE04"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","04-Contract year is provided incompletely","LH04"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","03-Contract year is provided incompletely","LN03"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","04-Contract year is provided incompletely","LM04"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","04-Contract year is provided incompletely","LP04"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","04-Contract year is provided incompletely","LV04"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","04-Contract year is provided incompletely","LA04"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Cobra - Eligibility information is provided inaccurately","LE01"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-Cobra - Eligibility information is provided inaccurately","LH01"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Cobra - Eligibility information is provided inaccurately","LN01"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","01-Cobra - Eligibility information is provided inaccurately","LM01"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-Cobra - Eligibility information is provided inaccurately","LP01"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-Cobra - Eligibility information is provided inaccurately","LV01"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","05-Cobra - Eligibility information is provided inaccurately","LA05"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Cobra - Eligibility information is provided incompletely","LE02"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-Cobra - Eligibility information is provided incompletely","LH02"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Cobra - Eligibility information is provided incompletely","LN02"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","02-Cobra - Eligibility information is provided incompletely","LM02"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-Cobra - Eligibility information is provided incompletely","LP02"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-Cobra - Eligibility information is provided incompletely","LV02"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","06-Cobra - Eligibility information is provided incompletely","LA06"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03-Cobra - Contract year is provided inaccurately","LE03"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","03-Cobra - Contract year is provided inaccurately","LH03"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Cobra - Contract year is provided inaccurately","LN02"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","03-Cobra - Contract year is provided inaccurately","LM03"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","03-Cobra - Contract year is provided inaccurately","LP03"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","03-Cobra - Contract year is provided inaccurately","LV03"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","07-Cobra - Contract year is provided inaccurately","LA07"]
[null,"L - Eligibility","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04-Cobra - Contract year is provided incompletely","LE04"]
[null,"L - Eligibility","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","04-Cobra - Contract year is provided incompletely","LH04"]
[null,"L - Eligibility","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","03-Cobra - Contract year is provided incompletely","LN03"]
[null,"L - Eligibility","M- Appeal Unit – Responsible for researching and approving appeals.","04-Cobra - Contract year is provided incompletely","LM04"]
[null,"L - Eligibility","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","04-Cobra - Contract year is provided incompletely","LP04"]
[null,"L - Eligibility","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","04Cobra - Contract year is provided incompletely","LV04"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","08-Cobra - Contract year is provided incompletely","LA08"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","09-Time frame-Eligibility time frame provided inaccurately","LA09"]
[null,"L - Eligibility","A - Advocate- Errors for the Advocate team","10-Time frame-Eligibility time frame provided incompletely","LA10"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided inaccurately","MC01"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided inaccurately","ME01"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided inaccurately","MH01"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided inaccurately","MP01"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided inaccurately","MS01"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","01 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided inaccurately","MA01"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided incompletely","MC02"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided incompletely","ME02"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided incompletely","MH02"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided incompletely","MP02"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided incompletely","MS02"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","02 - Provider Search/Selection - Network Insufficiency - Healthcare Professional contract information is provided incompletely","MA02"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","03 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided inaccurately","MC03"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided inaccurately","ME03"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","03 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided inaccurately","MH03"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","03 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided inaccurately","MP03"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","03 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided inaccurately","MS03"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","03 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided inaccurately","MA03"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","04 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided incompletely","MC04"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided incompletely","ME04"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","04 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided incompletely","MH04"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","04 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided incompletely","MP04"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","04 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided incompletely","MS04"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","04 - Provider Search/Selection - Network Insufficiency - Healthcare Professional Fee schedule is provided incompletely","MA04"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","05 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided inaccurately ","MC05"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","05 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided inaccurately ","ME05"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","05 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided inaccurately ","MH05"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","05 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided inaccurately ","MP05"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","05 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided inaccurately ","MS05"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","05 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided inaccurately ","MA05"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","06 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided incompletely ","MC06"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","06 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided incompletely ","ME06"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","06 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided incompletely ","MH06"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","06 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided incompletely ","MP06"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","06 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided incompletely ","MS06"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","06 - Provider Search/Selection - Network Insufficiency - Healthcare Professional/member portal call information is provided incompletely ","MA06"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","07 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","MC07"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","07 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","ME07"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","07 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","MH07"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","MN01"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","07 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","MP07"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","07 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","MS07"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","07 - Provider Search/Selection - Network Insufficiency - Vendor information is provided inaccurately","MA07"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","08 - Provider Search/Selection - Network Insufficiency - Vendor information is provided incompletely","MC08"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","08 - Provider Search/Selection - Network Insufficiency - Vendor information is provided incompletely","ME08"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","08 - Provider Search/Selection - Network Insufficiency - Vendor information is provided incompletely","MH08"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","08 - Provider Search/Selection - Network Insufficiency - Vendor information is provided incompletely","MP08"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","08 - Provider Search/Selection - Network Insufficiency - Vendor information is provided incompletely","MS08"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","08 - Provider Search/Selection - Network Insufficiency - Vendor information is provided incompletely","MA08"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","09 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MC09"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","09 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","ME09"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","09 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MH09"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MN02"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","01 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MM01"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","09 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MP09"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","09 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MS09"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","09 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided inaccurately","MA09"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","10 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MC10"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","10 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","ME10"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","10 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MH10"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","03 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MN03"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","02 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MM02"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","10 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MP10"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","10 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MS10"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","10 - Provider Search/Selection - Network status - Healthcare Professional contract information is provided incompletely","MA10"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","11 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MC11"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","11 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","ME11"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","11 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MH11"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","04 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MN04"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","03 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MM03"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","11 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MP11"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","11 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MS11"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","11 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided inaccurately","MA11"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","12 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","MC12"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","12 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","ME12"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","05 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","MN05"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","04 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","MM04"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","12 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","MP12"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","12 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","MS12"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","12 - Provider Search/Selection - Network status - Healthcare Professional Fee schedule is provided incompletely","MA12"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","13 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MC13"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","13 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","ME13"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","12 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MH12"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","06 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MN06"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","05-Z - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MM05"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","13 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MP13"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","13 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MS13"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","13 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided inaccurately ","MA13"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","14 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MC14"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","14 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","ME14"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","13 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MH13"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","07 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MN07"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","05 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MM05"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","14 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MP14"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","14 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MS14"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","14 - Provider Search/Selection - Network status - Healthcare Professional/member portal call information is provided incompletely ","MA14"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","15 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MC15"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","15 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","ME15"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","14 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MH14"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","08 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MN08"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","06 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MM06"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","15 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MP15"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","15 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MS15"]
[null,"M - Provider","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MV01"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","15 - Provider Search/Selection - Network status - Vendor information is provided inaccurately","MA15"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","16 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MC16"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","16 - Provider Search/Selection - Network status - Vendor information is provided incompletely","ME16"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","15 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MH15"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","09 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MN09"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","07 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MM07"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","16 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MP16"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","16 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MS16"]
[null,"M - Provider","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MV02"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","16 - Provider Search/Selection - Network status - Vendor information is provided incompletely","MA16"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","17 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MC17"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","17 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","ME17"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","16 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MH16"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","17 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MS17"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","17 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MA17"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","18 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MC18"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","18 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","ME18"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","17 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MH17"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","18 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MS18"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","18 - Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MA18"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","19 - Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MC19"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","19 - Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","ME19"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","18 - Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MH18"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","19 - Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MS19"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","19 - Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MA19"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","20 - Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MC20"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","20 - Provider Search/Selection - Out of Country - Vendor information is provided incompletely","ME20"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","19 - Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MH19"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","20 - Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MS20"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","21-Provider Search/Selection - Network status - Vendor information is provided incompletely","MC21"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","21-Provider Search/Selection - Network status - Vendor information is provided incompletely","ME21"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","20-Provider Search/Selection - Network status - Vendor information is provided incompletely","MH20"]
[null,"M - Provider","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","10-Provider Search/Selection - Network status - Vendor information is provided incompletely","MN10"]
[null,"M - Provider","M- Appeal Unit – Responsible for researching and approving appeals.","08-Provider Search/Selection - Network status - Vendor information is provided incompletely","MM08"]
[null,"M - Provider","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","17-Provider Search/Selection - Network status - Vendor information is provided incompletely","MP17"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","21-Provider Search/Selection - Network status - Vendor information is provided incompletely","MS21"]
[null,"M - Provider","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","03-Provider Search/Selection - Network status - Vendor information is provided incompletely","MV03"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","20 - Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MA20"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","22-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MC22"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","22-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","ME22"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","21-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MH21"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","22-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MS22"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","21-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided inaccurately ","MA21"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","23-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MC23"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","23-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","ME23"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","22-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MH22"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","23-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MS23"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","22-Provider Search/Selection - Out of Country - Healthcare Professional/member portal call information is provided incompletely ","MA22"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","24-Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MC24"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","24-Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","ME24"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","23-Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MH23"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","24-Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MS24"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","23-Provider Search/Selection - Out of Country - Vendor information is provided inaccurately","MA23"]
[null,"M - Provider","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","25-Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MC25"]
[null,"M - Provider","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","25-Provider Search/Selection - Out of Country - Vendor information is provided incompletely","ME25"]
[null,"M - Provider","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","24-Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MH24"]
[null,"M - Provider","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","25-Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MS25"]
[null,"M - Provider","A - Advocate- Errors for the Advocate team","24-Provider Search/Selection - Out of Country - Vendor information is provided incompletely","MA24"]
[null,"N - Empathy","M- Appeal Unit – Responsible for researching and approving appeals.","01 - Empathy-The Advocate does not acknowledge a hardship mentioned by the customer, or an obvious hardship caused by the product, process, or a previous contact to Cigna","NM01"]
[null,"N - Empathy","A - Advocate- Errors for the Advocate team","01 - Empathy-The Advocate does not acknowledge a hardship mentioned by the customer, or an obvious hardship caused by the product, process, or a previous contact to Cigna","NA01"]
[null,"N - Empathy","M- Appeal Unit – Responsible for researching and approving appeals.","02 - The Advocate  does not sound authentic and/or sounds scripted in interactions with the customer","NM02"]
[null,"N - Empathy","A - Advocate- Errors for the Advocate team","02 - The Advocate  does not sound authentic and/or sounds scripted in interactions with the customer","NA02"]
[null,"N - Empathy","A - Advocate- Errors for the Advocate team","03-The Advocate does not demonstrate interest  regarding the customers' issue ","NA03"]
[null,"N - Empathy","A - Advocate- Errors for the Advocate team","04 - The Advocate demonstrates some empathy, but misses opportunities to demonstrate empathy to better connect with the customer","NA04"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","01- Hipaa-Claim and/or referral information is changed/released without validating additional pieces of information. ","OA01"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","02-Hipaa-Information is changed/released to a non-validated caller. ","OA02"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","03-Hipaa-Personal health information is released to the caller. ","OA03"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","04-Hipaa-The caller was not told  that, \"the call is being recorded for Quality Assurance\", while making an Outbound Outreach Call","OA04"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","05-Hipaa-The pharmacy Advocate did not follow the O - Hipaa validation process in the PIT which now includes the ability to accept the NPI from a pharmacy","OA05"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","06- Hipaa-The zip code was not obtained for validation when the caller had an incorrect DOB or no DOB. ","OA06"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","07- Hipaa-The HCP was told that we could not confirm the DOB given was correct. ","OA07"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- Please verify customer's ID number or SSN, you looked up the customer by using the phone number. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- Please verify customer's ID number or SSN, you looked up the customer by using the prescription number. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- Please verify customer's ID number or SSN, you looked up the customer by name and date of birth. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- You cannot release the names of the medications to a parent who is checking a refill order for a dependent over the age of 18, the parent must give you the rx number or the name and strength of the medication. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- You cannot release the names of the medications to a parent who is placing a refill order for a dependent over the age of 18, the parent must give you the rx number or the name and strength of the medication. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- You cannot release the names of the medications to a spouse who is placing a refill order; the spouse must give you the RX # or the name and strength of the medication. The spouse provided the RX# and when closing the call – you provided the name of the medication instead of the RX#. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- You cannot release the names of the medications to a spouse who is placing a refill order, the spouse must give you the rx number or the name and strength of the medication. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- You cannot release the names of the medications to a spouse while reviewing an order for another family member who is not a minor. You can only confirm or deny once the data has been given to you. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- You cannot release the names of the medications to a parent who is not on the plan when they are checking the status of an order for a dependent over the age of 18. You can only confirm or deny. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA - You cannot access the customer’s Account by using the Customer First and Last Name, you are required to use Customers ID#  or SSN# and DOB -   PHI was / was not released"]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA - You cannot fill an order with the spouse if  the spouse only gives you the name of the medication. The Spouse must give you either the Rx number or the name and strength of the medication."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- When a doctor calls in and does not have the ID or SSN, you must verify the doctors NPI or DEA and a third piece of the customers information, like address or phone number. PHI was /was not released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- When speaking with a third party, please verify if there is a personal rep auth on file before releasing information. If no auth is on file, please have the third party/ personal rep give you the info to set up delivery. PHI was released."]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- Disclosure of information - While reviewing the account, you cannot release the names of the medications to a spouse who has not been verified. You can only confirm back the information that is given to you. Requirements are,  Full Name and DOB must be verified;           you verified only the primary member, not the spouse. "]
[null,"O - Hipaa","A - Advocate- Errors for the Advocate team","HIPAA- Disclosure of information -You cannot release the names of the medications to a spouse when they are placing a order. You can only confirm back the information that is given too you."]
[null,"P - ID Cards","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-ID card/material/healthcare professional directory information is provided inaccurately","PE01"]
[null,"P - ID Cards","A - Advocate- Errors for the Advocate team","01-ID card/material/healthcare professional directory information is provided inaccurately","PA01"]
[null,"P - ID Cards","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-ID card/material/healthcare professional directory information is provided incompletely","PE02"]
[null,"P - ID Cards","A - Advocate- Errors for the Advocate team","02-ID card/material/healthcare professional directory information is provided incompletely","PA02"]
[null,"Q - Manager Referral","A - Advocate- Errors for the Advocate team","01-Manager Referral-The Advocate was rude, defensive, and/or argumentative","QA01"]
[null,"Q - Manager Referral","A - Advocate- Errors for the Advocate team","02-Manager Referral-The Advocate’s comments were inappropriate","QA02"]
[null,"R - Opening","A - Advocate- Errors for the Advocate team","01-Opening-The Advocate does not use a professional greeting","RA01"]
[null,"R - Opening","A - Advocate- Errors for the Advocate team","02-Opening-The Advocate does not greet the caller promptly","RA02"]
[null,"S - Other General Information","A - Advocate- Errors for the Advocate team","01-Address/fax number/phone number information is provided inaccurately","SA01"]
[null,"S - Other General Information","A - Advocate- Errors for the Advocate team","02-Address/fax number/phone number information is provided incompletely","SA02"]
[null,"S - Other General Information","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","01-Cigna website information is provided inaccurately ","SO01"]
[null,"S - Other General Information","A - Advocate- Errors for the Advocate team","03-Cigna website information is provided inaccurately ","SA03"]
[null,"S - Other General Information","O - Other / Unknown - This code will be used only when there is not a more specific business owner code and a reasonable attempt is made to determine the area responsible.","02-Cigna website information is provided incompletely","SO02"]
[null,"S - Other General Information","A - Advocate- Errors for the Advocate team","04-Cigna website information is provided incompletely","SA04"]
[null,"S - Other General Information","A - Advocate- Errors for the Advocate team","05-The confirmation number is provided inaccurately","SA05"]
[null,"S - Other General Information","A - Advocate- Errors for the Advocate team","06-The confirmation number is provided incompletely","SA06"]
[null,"T - Outbound","A - Advocate- Errors for the Advocate team","01-The Advocate did not take full ownership and use the appropriate actions to resolve the caller’s request","TA01"]
[null,"T - Outbound","A - Advocate- Errors for the Advocate team","02- The Advocate did not advise the caller of our title(rep or tech) on outbound call","TA02"]
[null,"U - Ownership","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UC01"]
[null,"U - Ownership","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UE01"]
[null,"U - Ownership","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UH01"]
[null,"U - Ownership","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UN01"]
[null,"U - Ownership","M- Appeal Unit – Responsible for researching and approving appeals.","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UM01"]
[null,"U - Ownership","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UP01"]
[null,"U - Ownership","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","US01"]
[null,"U - Ownership","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UV01"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","01-The Advocate takes partial accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UA01"]
[null,"U - Ownership","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UC02"]
[null,"U - Ownership","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UE02"]
[null,"U - Ownership","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UH02"]
[null,"U - Ownership","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UN02"]
[null,"U - Ownership","M- Appeal Unit – Responsible for researching and approving appeals.","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UM02"]
[null,"U - Ownership","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UP02"]
[null,"U - Ownership","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","US02"]
[null,"U - Ownership","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UV02"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","02-The Advocate does not take accountability for the issue or request and/or places blame on policies, matrix partners etc     ","UA02"]
[null,"U - Ownership","M- Appeal Unit – Responsible for researching and approving appeals.","03-The Advocate does not follow up as committed to the customer","UM03"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","03-The Advocate does not follow up as committed to the customer","UA03"]
[null,"U - Ownership","M- Appeal Unit – Responsible for researching and approving appeals.","04-The Advocate fails to advise the correct timeframe when material; EOB or ID card is sent to a customer","UM04"]
[null,"U - Ownership","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","03-The Advocate fails to advise the correct timeframe when material; EOB or ID card is sent to a customer","US03"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","04-The Advocate fails to advise the correct timeframe when materials, EOB, ID card, etc. is sent to a customer","UA04"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","05-When transferring a non-validated caller to another agent, you advised the next representative that the caller was validated","UA05"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","06- The Advocate did not notify the caller that this is the last fill and that a renewal will be required for future fills","UA06"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","07-Refill/Renewal confirmation card verification –The Advocate did not verify the full address including city, state and zip code","UA07"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","08- Refill/Renewal confirmation card verification -  The Advocate did not recite back the prescription number or full name, form and strength of medication being refilled for the customer","UA08"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","09- Refill/Renewal confirmation card verification  - The Advocate did not obtain prescription number or full name, form and strength of med's being refilled for the customer by the spouse on the plan","UA09"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","10-The Advocate did not verify the full ship address including the zip code ","UA10"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","11- The Advocate did not offer to fax the HCP for the prescription","UA11"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","12- Polly Parrot procedure-The Advocate did not repeat or recap all of the delivery set-up information as a final step confirmation when scheduling the delivery","UA12"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","13 - The Advocate did not verify balance on account from previous order and try to obtain payment","UA13"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","14 – The Advocate did not  verify the last 4 digits of the credit card and expiration date","UA14"]
[null,"U - Ownership","A - Advocate- Errors for the Advocate team","15 – The Advocate did not obtain payment at the time of the order. Order was sent open charge and no order log notes were made as a onetime exception","UA15"]
[null,"V - Personality Flexing","M- Appeal Unit – Responsible for researching and approving appeals.","01-The Advocate does not sync up with the customer during the call","VM01"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","01-The Advocate does not correctly identify the customers personality type and/or does not respond appropriately ","VA01"]
[null,"V - Personality Flexing","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-The Advocate does not understand how their personality impacted and/or escalated the interaction","VC01"]
[null,"V - Personality Flexing","M- Appeal Unit – Responsible for researching and approving appeals.","02-The Advocate does not understand how their personality impacted and/or escalated the interaction","VM02"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","02-The Advocate does not sync up with the customer during the call","VA02"]
[null,"V - Personality Flexing","M- Appeal Unit – Responsible for researching and approving appeals.","03-The Advocate did not adapt the pace to match the customer","VM03"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","03-The Advocate does not understand how their personality impacted and/or escalated the interaction","VA03"]
[null,"V - Personality Flexing","M- Appeal Unit – Responsible for researching and approving appeals."," 04-The Advocate fails to recognize a distressed customer","VM04"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","04-The Advocate did not adapt the pace to match the customer","VA04"]
[null,"V - Personality Flexing","M- Appeal Unit – Responsible for researching and approving appeals.","05-The Advocate failed to recognize subtle verbal clues provided by the customer","VM05"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","05-The Advocate fails to recognize a distressed customer","VA05"]
[null,"V - Personality Flexing","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-The Advocate failed to recognize crucial information provided by the customer ","VC02"]
[null,"V - Personality Flexing","M- Appeal Unit – Responsible for researching and approving appeals.","06-The Advocate failed to recognize crucial information provided by the customer ","VM06"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","06-The Advocate failed to recognize subtle verbal clues provided by the customer","VA06"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","01-The Advocate responds to the customer using negative language ","WM01"]
[null,"V - Personality Flexing","A - Advocate- Errors for the Advocate team","07-The Advocate failed to recognize crucial information provided by the customer ","VA07"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","02-NThe Advocate uses a harsh or negative tone","WM02"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","01-The Advocate responds to the customer using negative language ","WA01"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","03-The Advocate uses phrases that are belittling or condescending","WM03"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","02-The Advocate uses a harsh or negative tone","WA02"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","04-The Advocate tells customers what can’t be done instead of what can be done to correct the problem or issue","WM04"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","03-The Advocate uses phrases that are belittling or condescending","WA03"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","05-The Advocate doesn’t provide additional information (the \"why\") or options to the customer when available","WM05"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","04-The Advocate tells customers what can’t be done instead of what can be done to correct the problem or issue","WA04"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WC01"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WE01"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WH01"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WN01"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","06-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WM06"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WP01"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WS01"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WV01"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","05-The Advocate doesn’t provide additional information (the \"why\") or options to the customer when available","WA05"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-The Advocate does not display a willing, caring attitude throughout the call","WC02"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-The Advocate does not display a willing, caring attitude throughout the call","WE02"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-The Advocate does not display a willing, caring attitude throughout the call","WH02"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-The Advocate does not display a willing, caring attitude throughout the call","WN02"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","07-The Advocate does not display a willing, caring attitude throughout the call","WM07"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-The Advocate does not display a willing, caring attitude throughout the call","WP02"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-The Advocate does not display a willing, caring attitude throughout the call","WS02"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-The Advocate does not display a willing, caring attitude throughout the call","WV02"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","06-The Advocate asked the caller for their phone number utilizing verbiage such as “…in case they were disconnected”","WA06"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","03-The Advocate does not use positive words and/or phrases","WC03"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","03-The Advocate does not use positive words and/or phrases","WE03"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","03-The Advocate does not use positive words and/or phrases","WH03"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","03-The Advocate does not use positive words and/or phrases","WN03"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","08-The Advocate does not use positive words and/or phrases","WM08"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","03-The Advocate does not use positive words and/or phrases","WP03"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","03-The Advocate does not use positive words and/or phrases","WS03"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","03-The Advocate does not use positive words and/or phrases","WV03"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","07-The Advocate does not display a willing, caring attitude throughout the call","WA07"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WC04"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WE04"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WH04"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WN04"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","09-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WM09"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WP04"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WS04"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","04-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WV04"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","08-The Advocate does not use positive words and/or phrases","WA08"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","05-The Advocate over utilizes pleasantries","WC05"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","05-The Advocate over utilizes pleasantries","WE05"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","05-The Advocate over utilizes pleasantries","WH05"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","05-The Advocate over utilizes pleasantries","WN05"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","10-The Advocate over utilizes pleasantries","WM10"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","05-The Advocate over utilizes pleasantries","WP05"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","05-The Advocate over utilizes pleasantries","WS05"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","05-The Advocate over utilizes pleasantries","WV05"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","09-The Advocate sounds monotone/robotic/scripted and does not display a genuinely enthusiastic tone","WA09"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","06-The Advocate under utilizes pleasantries","WC06"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","06-The Advocate under utilizes pleasantries","WE06"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","06-The Advocate under utilizes pleasantries","WH06"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","06-The Advocate under utilizes pleasantries","WN06"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","11-The Advocate under utilizes pleasantries","WM11"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","06-The Advocate under utilizes pleasantries","WP06"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","06-The Advocate under utilizes pleasantries","WS06"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","06-The Advocate under utilizes pleasantries","WV06"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","10-The Advocate over utilizes pleasantries","WA10"]
[null,"W - Positive Language","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","07-The Advocate uses inappropriate and/or unprofessional comments","WC07"]
[null,"W - Positive Language","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","07-The Advocate uses inappropriate and/or unprofessional comments","WE07"]
[null,"W - Positive Language","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","07-The Advocate uses inappropriate and/or unprofessional comments","WH07"]
[null,"W - Positive Language","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","07-The Advocate uses inappropriate and/or unprofessional comments","WN07"]
[null,"W - Positive Language","M- Appeal Unit – Responsible for researching and approving appeals.","12-The Advocate uses inappropriate and/or unprofessional comments","WM12"]
[null,"W - Positive Language","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","07-The Advocate uses inappropriate and/or unprofessional comments","WP07"]
[null,"W - Positive Language","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","07-The Advocate uses inappropriate and/or unprofessional comments","WS07"]
[null,"W - Positive Language","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","07-The Advocate uses inappropriate and/or unprofessional comments","WV07"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","11-The Advocate under utilizes pleasantries","WA11"]
[null,"X - Precertification","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-Advanced Radiology Imaging information is provided inaccurately","XS01"]
[null,"W - Positive Language","A - Advocate- Errors for the Advocate team","12-The Advocate uses inappropriate and/or unprofessional comments","WA12"]
[null,"X - Precertification","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-Advanced Radiology Imaging information is provided incompletely","XS02"]
[null,"X - Precertification","A - Advocate- Errors for the Advocate team","01-Advanced Radiology Imaging information is provided inaccurately","XA01"]
[null,"X - Precertification","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-Pre certification/pre determination/referral information is provided inaccurately","XC01"]
[null,"X - Precertification","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Pre certification/pre determination/referral information is provided inaccurately","XE01"]
[null,"X - Precertification","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-Pre certification/pre determination/referral information is provided inaccurately","XH01"]
[null,"X - Precertification","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Pre certification/pre determination/referral information is provided inaccurately","XN01"]
[null,"X - Precertification","M- Appeal Unit – Responsible for researching and approving appeals.","01-Pre certification/pre determination/referral information is provided inaccurately","XM01"]
[null,"X - Precertification","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-Pre certification/pre determination/referral information is provided inaccurately","XP01"]
[null,"X - Precertification","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-Pre certification/pre determination/referral information is provided inaccurately","XS03"]
[null,"X - Precertification","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-Pre certification/pre determination/referral information is provided inaccurately","XV01"]
[null,"X - Precertification","A - Advocate- Errors for the Advocate team","02-Advanced Radiology Imaging information is provided incompletely","XA02"]
[null,"X - Precertification","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-Pre certification/pre determination/referral information is provided incompletely","XC02"]
[null,"X - Precertification","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Pre certification/pre determination/referral information is provided incompletely","XE02"]
[null,"X - Precertification","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-Pre certification/pre determination/referral information is provided incompletely","XH02"]
[null,"X - Precertification","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","02-Pre certification/pre determination/referral information is provided incompletely","XN02"]
[null,"X - Precertification","M- Appeal Unit – Responsible for researching and approving appeals.","02-Pre certification/pre determination/referral information is provided incompletely","XM02"]
[null,"X - Precertification","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-Pre certification/pre determination/referral information is provided incompletely","XP02"]
[null,"X - Precertification","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","04-Pre certification/pre determination/referral information is provided incompletely","XS04"]
[null,"X - Precertification","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-Pre certification/pre determination/referral information is provided incompletely","XV02"]
[null,"X - Precertification","A - Advocate- Errors for the Advocate team","03-Pre certification/pre determination/referral information is provided inaccurately","XA03"]
[null,"X - Precertification","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","05-The Advocate did not follow the process for ARI inquiries found in the Advanced Radiology Imaging Call Handling or the Advanced Radiology Imaging ARI Health Care Professional Call Handling","XS05"]
[null,"X - Precertification","A - Advocate- Errors for the Advocate team","04-Pre certification/pre determination/referral information is provided incompletely","XA04"]
[null,"X - Precertification","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","05-The Advocate did not perform a warm transfer to the ARI team","XS05"]
[null,"X - Precertification","A - Advocate- Errors for the Advocate team","05-The Advocate did not follow the process for ARI inquiries found in the Advanced Radiology Imaging Call Handling or the Advanced Radiology Imaging ARI Health Care Professional Call Handling","XA05"]
[null,"Y - Predetermination","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","01-Advanced Radiology Imaging information is provided inaccurately","YS01"]
[null,"X - Precertification","A - Advocate- Errors for the Advocate team","06-The Advocate did not perform a warm transfer to the ARI team","XA06"]
[null,"Y - Predetermination","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","02-Advanced Radiology Imaging information is provided incompletely","YS02"]
[null,"Y - Predetermination","A - Advocate- Errors for the Advocate team","YA01 not to be used at this time","YA01"]
[null,"Y - Predetermination","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","01-Pre certification/pre determination/referral information is provided inaccurately","YC01"]
[null,"Y - Predetermination","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","01-Pre certification/pre determination/referral information is provided inaccurately","YE01"]
[null,"Y - Predetermination","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","01-Pre certification/pre determination/referral information is provided inaccurately","YH01"]
[null,"Y - Predetermination","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Pre certification/pre determination/referral information is provided inaccurately","YN01"]
[null,"Y - Predetermination","M- Appeal Unit – Responsible for researching and approving appeals.","01-Pre certification/pre determination/referral information is provided inaccurately","YM01"]
[null,"Y - Predetermination","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","01-Pre certification/pre determination/referral information is provided inaccurately","YP01"]
[null,"Y - Predetermination","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","03-Pre certification/pre determination/referral information is provided inaccurately","YS03"]
[null,"Y - Predetermination","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","01-Pre certification/pre determination/referral information is provided inaccurately","YV01"]
[null,"Y - Predetermination","A - Advocate- Errors for the Advocate team","YA02 not to be used at this time","YA02"]
[null,"Y - Predetermination","C - Claim - Responsible for processes and claim payment data, including Policies & Procedures.","02-Pre certification/pre determination/referral information is provided incompletely","YC02"]
[null,"Y - Predetermination","E - Employer Services - Responsible for loading eligibility, and plan benefit information, and system configuration into the claim systems and source systems. (i.e., ePro, Benefit Access, CED, CDB, BQR, BRC, CIT & Plan Specs)","02-Pre certification/pre determination/referral information is provided incompletely","YE02"]
[null,"Y - Predetermination","H - Health Facilitation Center/Claim Nurse Review - Responsible for loading Authorizations, Referrals, and Precertification. Also responsible for Nurse Reviews, Medical Review, and Case Management.","02-Pre certification/pre determination/referral information is provided incompletely","YH02"]
[null,"Y - Predetermination","N - Contracting - Specific to the actual provide contract. Errors may be applied if the contract is non-standard or difficult to administer causing claim errors, or if it was retroactively updated causing a claim error.","01-Pre certification/pre determination/referral information is provided incompletely","YN01"]
[null,"Y - Predetermination","M- Appeal Unit – Responsible for researching and approving appeals.","02-Pre certification/pre determination/referral information is provided incompletely","YM02"]
[null,"Y - Predetermination","P - Total Health & Network - Responsible for loading provider/contract data. (PDO/Net Ops)","02-Pre certification/pre determination/referral information is provided incompletely","YP02"]
[null,"Y - Predetermination","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","04-Pre certification/pre determination/referral information is provided incompletely","YS04"]
[null,"Y - Predetermination","V -  Vendor - Responsible for data entry of claim information from a data entry vendor. (ACS) Prior to 2011, it was ACS/Diversified)","02-Pre certification/pre determination/referral information is provided incompletely","YV02"]
[null,"Y - Predetermination","A - Advocate- Errors for the Advocate team","YA03 not to be used at this time","YA03"]
[null,"Y - Predetermination","A - Advocate- Errors for the Advocate team","YA04 not to be used at this time","YA04"]
[null,"Y - Predetermination","S - Standard Operation Procedures - Call P&P, SOP unclear inaccurate","05-The Advocate did not perform a warm transfer to the ARI team","YS05"]
[null,"Y - Predetermination","A - Advocate- Errors for the Advocate team","YA05 not to be used at this time","YA05"]
[null,"Y - Predetermination","A - Advocate- Errors for the Advocate team","YA06 not to be used at this time","YA06"]