Final 1
If someone who doesn't have Medicare calls with questions, how do you handle this call?
What is look for a contact record and if one doesn't exist create a new activity record or add the contact record if one doesn't exist.
John Wilson is calling on behalf of his father, James Wilson. There is no authorization on file and his father can't come to the phone but, John does have an MSN and has some questions about it. What should you do?
Ask Mr. Wilson to confirm all 4 pieces of disclosure and then say, “I’d be happy to answer your questions about that Medicare Summary Notice.”
Where in NGD can you look to see a beneficiary has an open escalation.
What is the beneficiary indicators.
A beneficiary calls in and tells you she has a doctor's appointment tomorrow and doesn't have internet access but, she needs proof of coverage immediately, how can you help the bene?
Refer her to her local SSA office.
Where in NGD can you check to see if the beneficiary has another insurance that should pay before Medicare?
Other Insurance view under MSP
What tool do we use in NGD to make sure the beneficiary doesn't have to repeat their questions or concerns.
What is the Dashboard
If a caller has an MSN, we understand that we can give information related to the MSN. If the caller has additional questions about why his dental visit wasn't covered but, it's not on that MSN what are the next steps?
Use the Medicare Part B Coverage script to explain how Medicare covers dental services.
Once you locate an escalation and determine that it's an MA PDP complaint task escalation, which script do you use to determine your next steps?
Plan Concerns and Complaints
You receive a call from a SHIP counselor on behalf of a beneficiary what script do you use to find out your next steps?
What is the Authorizations script.
What steps do you take if the bene states that they had employer coverage but, recently retired but we still show the information in NGD?
Check the Termination Date field in the Medicare Secondary Payer MSP (Pays before Medicare) list applet to submit a simple termination and follow the termination message to either transfer to claims for termination or refer to BCRC
What's another insurance a beneficiary may have to help pay for copayments, coinsurance and deductibles?
What is a Medigap policy.
What mailing will the beneficiary receive if Medicare enrolled her into a PDP plan? And what color is it?
What is a green letter (Facilitated Enrollment Notice)
If there is already an open escalation how many days do you have to wait to submit another escalation?
What is 30 days.
What are the steps in you have to take when speaking with a SHIP counselor?
You have to pass disclosure, verify the SHIP ID number and then you can answer his/her questions as if the beneficiary were on the line.
If the beneficiary switch supplemental insurance companies what script so we use to give them next steps?
Supplemental Crossover of Claims
True or False....A beneficiary can have both a MA plan and a Medigap policy.
False
A beneficiary calls in on July 23, 2022, because they are unhappy with their coverage and wants to switch to Original Medicare with a PDP, which enrollment period would allow them to switch as soon as possible.
A beneficiary contacts Medicare on March 9, 2022, about an escalation that was submitted on February 22, 2022. You explain the status of the escalation to the bene but, the bene still has questions according to scripting what should you do?
Tell the beneficiary to contact her plan for more information or to ask additional questions.
Which script would you use to order additional copies of the Medicare and You handbook?
What is the Publication Availability script.
What script would you access if the beneficiary states that they need assistance with their Medicare cost (prescriptions, deductibles, copayments etc.)?
Applying for Low-Income Assistance
A beneficiary calls in and has questions about what Medicare covers related to Dental services, what's the best script to use when inquiring about this service?
Medicare Part B Coverage
Where in NDG can we find if a beneficiary has Opt out of autoenrollment?
What is the MA PDP Information form applet
How many days do you wait to order a new Medicare card if a card has been recently ordered?
What is 30 days.
A beneficiary calls in with a question about a denied claim listed on their MSN, you want to use the Claims Quick View to look up the claim, where do you start?
BCC Tier 1 screen Claims view
Where do we go in NGD to check to see if a beneficiary is eligible for a Yearly Annual Wellness Visit?
Preventive Services View