Panviva Cause Yall not Using it
Provide all steps to unlock a GCNJ account when it says inactive
Select the Callers Email Address
Change Status to Active
Click Save and Sent
What options do consumers have for receiving a 1095A?
Postal Mail and Secure Inbox ONLY
What is the script you read when the enrollment status says Pending and the consumer wants to know why.
Your enrollment with <company name>, is pending. When your carrier receives your first payment, the system will be updated to show your enrollment status as confirmed. You will need to make your first payment, binder payment, before your effective date."
What are the 5 acceptable DMI file types that consumers can upload?
Accepted DMI File Types:
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What type of PHI/PII should NEVER be divulged - Even if you have validated the consumer.
DOB, SSN, Address, Phone Number, Email Address
Provide 4 Qualifying Life Events AND provide the name of one of the documents that provides the list
Adoption or Court ordered dependent
Birth
Change in Incarceration Status
Change in Legal Presence
Death
Divorce
Loss/Gain Tax dependent
Loss of coverage through employer
Loss of Medicaid
Loss of other minimum essential coverage
Marriage
Moved into State
Pregnancy
Types of Qualifying Life Events Determine the Type of QLE
The consumer stated they received multiple 1095-A’s, and ask which one of them is correct? What should you say?
Each Qualified Health Plan will result in a 1095-A. If the consumer changed coverage in 2022, they will receive multiple forms
DOUBLE POINTS IF READ WORD FOR WORD FROM PANVIA....
When does a Special Enrollment Period occur for a consumer AND when does it close for the consumer.
Special Enrollment Period occurs when a consumer reports a Qualifying Life Event (QLE). This can happen any time during a plan year. The policy effective date will be dictated by the type of QLE reported by the consumer.
Closes Once the consumer selects a plan
Where do you confirm the status of a DMI? Provide the steps that are in Panviva
Click on Manage Members from the top menu.
Search for and select consumer.
Navigate to About Consumer on the left-hand side.
Click on Ticket History
Click on the appropriate Ticket ID.
What types of details should be included in an 834 request?
EXACTLY what is showing in the carriers system and what in GCNJ's system as it relates to: Subsidies, Net premium, Effective dates, Members on the policy, etc.
What are the steps to adding an authorized representative?
Name 2 reasons why a consumer would not receive a 1095A?
They did not have coverage for the year
They had a catastrophic plan (verify by clicking additional info and look at the Coverage Tier)
If a consumer is denied NJFC and they want to backdate their enrollment, is this a CP Task or placed on the Supervisor tracker? Also, what is the 1st step before the request can be submitted and the name of the document in Panviva?
Task in CP using the appropriate stock text
You must call NJFC to confirm the denial date.
Backdate Enrollment - Denied NJFC
How do you report Medicaid denials in GCNJ?
Update the app and find the question were you recently denied njfc /Medicaid in the past 90 days
What QLE can be reported and automatically granted and is available throughout the year?
Incomes under 200% of FPL.
This SEP is available throughout the year and will be automatically granted based on a consumer's income.
If Consumer has questions about the summary of benefits they are eligible for, where do you locate this?
Impersonate the Member
My Enrollments
My Eligibility Results and review the summary
Clarifying premiums document in Panviva
DOUBLE POINTS!!! How to Handle the Situation when Policy is canceled due to Nonpayment on GCNJ and consumer requests corrected 1095 A form .
Advise them : Your Form 1095-A will reflect that no premium was paid for that month(s) and will not show a SLCSP(second Lowest Cost Silver Plan ) for the month(s) affected, but the carrier would have already received that month(s) APTC, so you may still see the APTC being paid to the carrier during that month(s).
If Consumer or Carrier States that Policy stayed active with carrier or they want to put Non pay reinstatement request as they were not aware of this Nonpayment Termination. Conference carrier and follow Nonpayment reinstatement Process from Panviva . Once Carrier will reinstate their Policy , System will issue corrected 1095 A form.
If a broker needs to reset their PW, what question should you ask them?
Have you selected the Forgot Password option and attempted to reset your Password.
If consumer has inquired about their APTC amount changing what are 2 probing questions that you can ask.
Has your income or tax household changed?
Do you have a multi person household
Have you filed your previous year taxes
Have you reconciled your APTCs
Have you Fulfilled all required DMIs
Rihanna called regarding a previous issue and you see that a task was created in CP and is ON HOLD. What do you do?
Croll to the bottom to see the task notes. If there is info requested by the back office, obtain the needed information from the consumer.
Click Edit task, update the info OR type a new note at the bottom of the task
Re-assign the task (Leave blank if the status is created) Or send it back to whoever requested the update)
How do you know if the consumer has already entered their information into the IVR
The last 4 of the SSN and DOB will be prepopulated
Provide 2 Circumstances we need to create Task and 2 circumstances that we would NOT create a task in CP Regarding 1095 A Form ?
ONLY when Information on the consumer's 1095-A does not match the information on the consumer's application(s)
The name on the 1095A form and Get Covered NJ Application does not match ( Task Needed)
Social Security on the 1095A form and GetCovered NJ Application do not match ( Task Needed)
Date of birth on the 1095A form and GetCovered NJ Application do not match ( Task Needed)
***Consumer has any demographic changes (SSN/Name/DOB ) and Information was never updated on their 2022 application They can correct it directly on their tax form , Advice then to Update their 2023 application with correct information .( No Task Needed)
APTC received on the Enrollment Do not Match 1095 A form
***If Consumer's APTCs or Coverage were affected by DMI ROP Task ( No Task Needed)
Enrollments Dates / and Enrollees Information do not Match 1095 A form
***If Policy is canceled due to Nonpayment ( Follow Termination for Non-Payment )
***If Premium on their 1095 A form is slightly different that Premium on 1095 A form. remember on 1095 A form they just post EHB( Essential Health Benefits Premium )
If consumer was auto renewed for 2023 without any financial assistance, what should you advise them to do to fix it.
Where do you find the reason for a policy termination? Provide 2 examples of what could be listed.
Enrollments csr view - Additional info part b. voluntary withdrawal consumer called to term , benefits selection - DMI, Non Payment - termed by the carrier
What information is required for a request to Backdate Subsidies to the beginning of the current month. (Hint: what info is listed in the task request)
Request for Subsidy Backdate.
Consumer's Full Name
List all other member's who are enrolled
Policy #:
Requested Date:
Reason for Backdate:
Name of the Caller and specific topic for the consumers request.