Your plan's hidden treasure chest
Because benefits and vendor partnerships can vary significantly, you should never make this assumption when helping a member.
What is assuming benefits are identical (or assuming member details)?
This status is used when attending training classes after becoming a guide.
What is Training and Coaching?
This term describes the excessive and inappropriate accumulation of prescription or OTC medications by members for later use
What is stockpiling?
AHS cases are created for these two types of outreaches
What are provider outreaches and pharmacy outreaches?
If you pass this initial checkpoint, these two later check-ins — the 60-day and 90-day reviews — are no longer on your calendar.
What is the 30-day review?
This Medicare benefit covers prescription drugs and is listed alongside the supplemental benefits list.
What is Medicare Part D?
This status must be set before logging off for the day
What is Offline?
Because benefits reset on this date each year, new members can end up with accidental extra medication fills.
What is January 1st?
This is the status a member is at, with no D2Me, that signals a need for EDC — it means they're close to running out completely
What is Guaranteed Non-Adherence (GNA)?
This tab in Orinoco is where you'd look to find any upcoming appointments.
What is Open Activities?
True or False: Orginal Medicare covers routine dental exams and cleaning?
False
To create a three-way call before completing a transfer, you select this button in TalkDesk.
What is Add to Consultation?
Instead of assuming a member is non-adherent, guides should ask questions to uncover this.
What is the "why" (what's really happening)?
Before beginning a medication review, guides must verify this and build this with the member."
What are HIPAA (verification) and rapport?
This is the tab where MAGII work lives.
What is the Action Plan tab?
Listed among the common supplemental benefits, this popular fitness program starts with the letter S.
What is Silver Sneakers?
This is the number of minutes of grace you have when logging in, coming back from a break or lunch, or clocking out for the day before you're marked LTR or ETL.
What is two minutes?
This is one of the four questions guides should ask to identify the why behind a member's medication supply, involving checking the container itself
What date is on the bottle?
If a member is enrolled in CVSMO/MOT and has no refills available, this is the maximum number of warm transfer attempts a guide should make before manually creating an EDC case.
What is two (2) attempts?
Check this tab to see if anyone other than the member is authorized to talk to you about the member's plan.
What is the Care tab?
Durable Medical Equipment (DME) is a good example of this type of Medicare coverage coordination.
What is Part B (or coordination of Medicare coverage)?
This is when your Talkdesk status automatically changes to Available after you complete your documentation — hint: you don't need to wait for it
What is now (immediately)
To find open adherence gaps in the system, guides should check this box to see medication renewal needs.
Display Gap & Opportunity Details
This 5-step process — which includes verifying HIPAA and building rapport, reviewing all MAGII medications, checking adherence gaps, asking why if a refill is declined, and knowing what to do when no refills are available — is summed up by the phrase 'It's All in the ___.
What is the Protocol?
This team helps with monthly raffles and team swag.
What is the Engagement Team?