CI
Which screen in CI provides information on a member's Medicaid eligibility level?
MEVH
Which characteristic is true for members who are cost share protected?
A) Members are limited to $10 out of pocket costs
B) They member is not responsible for payment of their cost-share
C) Members pay one PCP copay annually
D) Humana and the member share service costs
B) They member is not responsible for payment of their cost-share
Which is a correct statement regarding election periods for dual eligible members?
A) Duals receive no additional election periods
B) Annual Enrollment is from 6/1 to 12/31
C) SEP for Dual Eligible- Once per calendar quarter during the first 9 months
D) Open enrollment 4/1 - 8/31
C) SEP for Dual Eligible- Once per calendar quarter during the first 9 months
Which tool should be used to quote DE-SNP plan benefits?
DEBUT
Which of the following criteria are enrollment requirements for a CSNP plan? Select ALL that apply.
A) Enrollment Application X
B) Pre-Qualification VCC form X
C) Agent Facilitated X
D) DOI Approval
E) CMS Approval
A) Enrollment Application
B) Pre-Qualification VCC form
C) Agent Facilitated
E) CMS Approval
Which CI screen will show if the verification of chronic condition VCC form has been received from a member.
CSNP
What are the characteristics of cost share protection? Select all that apply.
A) Member is not responsible for payment of their cost-share.
B) The member cannot be balance billed for an outstanding balance or their responsibility.
C) All member EOBs are suppressed (not mailed) for D-SNP plans.
D) A member cannot have a previous balance with the provider.
A) Member is not responsible for payment of their cost-share.
B) The member cannot be balance billed for an outstanding balance or their responsibility.
C) All member EOBs are suppressed (not mailed) for D-SNP plans.
What initiates a grace period?
When a member loses full Medicaid or the required level of Medicaid Eligibility for the
plan
Who is eligible for the Humana Value Plus plan?
Anyone eligible for Medicare
A dual eligible member is considered in deeming status if they lose _______eligibility.
Medicaid
Which ID card should a DE-SNP member present when receiving services?
Humana and Medicaid ID cards
Which of the following is NOT considered a SNP?
A) I-SNP
B) D-SNP
C) C-SNP
D) B-SNP
D) B-SNP
When verifying benefits what are 2 eligibility status criteria that should be confirmed?
Dual Eligibility & Cost Share Protection Status
What is the maximum duration of a DE-SNP grace period?
6 months
Which chronic condition is considered an approved condition for a special needs plan?
A) Cancer
B) Diabetes Melletus
C) Alzheimers
D) Migraine
B) Diabetes Melletus
What are the requirements for Humana's D-SNP plan enrollment? Select all that apply
A) Must live in the service area
B) Cannot have ESRD
C) Must have a qualifying level of Medicaid
D) Must have or be eligible for Part A and Part B
E) Cannot have an outstanding bill with a participating provider.
A) Must live in the service area
B) Cannot have ESRD
C) Must have a qualifying level of Medicaid
D) Must have or be eligible for Part A and Part B
Which of the following is not a characteristic of AdPay in CAS?
A) Pay the Humana cost share portion for D-SNP members
B) The charge and allowed amounts reflect the State Cost share amount
C) The SNPDE cause code for duals claims.
D) Will pend until the state makes a determination on the claim
D) Will pend until the state makes a determination on the claim
Which of the below should be used when quoting benefits for cost-share protected HVP members?
The Benefit Grid
Which statement is true regarding DE-SNP member's explanation of benefits?
EOBs are suppressed
Which chronic condition is NOT included in the special needs plan design.
A) CVD Cardiovascular Disease
B) CHF Congestive Heart Failure
C) DM Diabetes Mellitus
D) PKD Parkinson Disease
D) PKD Parkinson Disease