Disclosure
You get a call from Meeko who just turn 65, He isn't enrolled in Medicare but has questions. How would you handle his call in NGD?
Look for contact record or create a new activity record
You get a call from Baloo and he is interested in learning about Supplemental insurance that helps reduce cost associated with Original Medicare copayments, coinsurance, and deductibles. What kind of policy is that?
Medigap
Tantar called in about a denied claim. Where do we start our claim search in NGD? (Screen and view name)
BBC Tier 1 screen Claims View
Timone is a SHIP agent calling on behalf of Pumba. Which script would you use to determine what information you can give them?
Authorizations
Sharkbait is planning to enroll in Original Medicare, but he thinks a prescription drug plan is a waste of money. If Sharkbait chooses not to enroll in a prescription drug plan now, he might have to pay a late enrollment penalty if he enrolls in the future. How long would he have to pay the penalty?
For as long as he has Medicare Prescription Drug coverage
You get a call from Zazu and he tells you he lost his Medicare card and needs a new one. What do we need to ask for instead of the Medicare number to pass disclosure?
Ask for Social Security Number
Lumiere wants to know if he is opted out of autoenrollment for his MA-PDP plan. Which applet on the MA-PDP view can we see that in NGD?
MA-PDP Information form applet
On the BBC Tier 1 screen Claims view, What are the two ways we can search a claim?
Date of service and/or claim number
Edna Mode received a green letter for her PDP plan is confused about it. What is the green letter?
Facilitated Enrollment Notice
Judy Hops is unhappy with the new plan and would like to switch from Original Medicare and PDP to a Medicare Advantage prescription drug. You see that Mrs. Hops also has an Extra Help. Which of the following enrollment periods would allow her to switch?
Special Election Period
Iago called in asking questions about Medicare. Where do we record Iago questions so he doesn't have to repeat himself?
Dashboard
Mushu asks about having Medicare Advantage plan and a Medigap plan at the same time. Can he have both?
No; he can only enroll in either or.
What button to we press to see more information about the claim?
Load Claim Details
Ray called in saying he lost his Medicare card and needs a new one. He says he doesn't have internet access and is going to the doctor tomorrow. How would we help Ray?
Refer him to his local SSA office.
You get a call from Chip, who is a (SHIP) counselor. He’s calling on behalf of Dale about a Claim. You verify Mr. Chip’s SHIP ID number, and he passes disclosure. Can you answer Mr. Chip’s questions about Mr. Dale’s claims?
Yes, you can answer his questions as if the beneficiary were on the line.
Simba is calling on behalf of his dad, Mufasa. There is no authorization on file and Mufasa is busy. Simba has the MSN available and has questions about it. What can we do?
Pass disclosure and only answer questions about the MSN.
You geta call from Ember and she said she hasn't received her Medicare card from her MA-Plan. She wants to file a complaint. Which script would you use to help her?
Plan Concerns and Complaints.
We see that the claim stated it was denied because Medicare is a secondary payer. What do we need to tell Tantar? Hint: (What does that mean?)
Tantar has other insurance that should've paid first.
Rasputin filed a complaint with us on February 20, 2025 and is calling on March 8th, 2025 because they still haven't received their card from their MA-Plan. Should we file another complaint? Why or why not? (2 Part answer)
No, Because it hasn't been more than 30 days since the complaint was escalated.
Yzma is unhappy that she was enrolled into a plan without her permission and doesn’t want it to happen again. What can Mrs. Yzma do to ensure that she isn’t automatically enrolled in a plan in the future?
Opt out of Autoenrollment
Simba is calling on behalf of his dad, Mufasa. There is no authorization on file and Mufasa is busy.
Simba has a question about a glaucoma screening; can he give him his information and what script do we use? (Two Answers)
Yes, because it is general information, Use Medicare Part B coverage script
You get a call from Merryweather and she said she hasn't received her Medicare card from her MA-Plan. She already has an open escalation on her plan and you explain the status of her complaint to her but she still has more questions. What do we do next?
Refer her to her Ma-Plan.
The claims stated that it was denied because Medicare is a secondary payer. Tantar asked how he gets this resolved. What do we tell him?
Have his provider resubmit the claim to their primary insurance.
You get a call from Lilo and she wants to know what Medicare covers when she goes to the Doctor's office. What script would we use to answer her question?
Medicare Part B Coverage
Lighting McQueen calls into Medicare. You find an open MA-PDP Complaint escalation for the issue he is calling about. Which of the following fields can you use to give Mr. McQueen the status of the escalation? (Two Answers)
Case Status and Resolution Summary