"To be or NOT to be"
What is ALIGNED and who do we service?
Aligned - DSNP and Medicaid with UHC - you will service both plans
Who dreamed of becoming a music teacher but went into the military?
Barbaraaaaaaaaaaaaaaaaaaaa
True or False: Balance billing is allowed?
False: Balance billing is NOT allowed.
How many DSNP plans do the state of CO have? What is it?
1
Rocky Mountain Health Plans DualCare Plus (HMO D-SNP)
H2582-002 2023
What does CMS stands for?
Centers for Medicare & Medicaid Services
What is the source of truth to determine eligibility?
MARx-CMS
Who played the following 3 instruments in our training class?
Saxophone, flute, trumpet
Saishaaaaaaaaaaaaa
True or False- In the state of AZ member has 30 calendar days to file for a grievance.
False- There is not a filing limit for a grievance. A member may file a grievance at any time; there is not a filing limit for a grievance. The member may communicate a grievance to UHCCP verbally or in writing. UHCCP should attempt to resolve all grievances within 10 days, but no longer than 90 days. All grievances must be documented, tracked and reported back to AHCCCS.
Note:
Appeals & Grievances section)
What does AHCCCS stands for? What is it?
(ACC) is an integrated health insurance plan regulated by the state’s Medicaid agency, Arizona Health Care Cost Containment System (AHCCCS).
What SOP do you reference for "one breath situations."
"Situational Guidelines- One Breath Chat Advocate"-KM1573859
Explain the steps to request a new ID card in facets?
Address Tab ---> Subject: ID Cards ----> Category: Lost/Stolen ---> Add Notes and Save Task
Who is the mayor of TX in our training?
Say it with me LOUD AND PROUD....JAMESSSSSSS
True or False; For CO members have access to both the member portal & the eligibility portal??
False
What does MTBA stands for?
MTBA - Medical Transportation Brokerage of AZ
What does the networkX Std fee Schedule mean?
A list of fees for specific health care services that an insurance company will use to pay doctors and other health care providers.
Explain the steps you will take to locate a claim in Facets?
Medical Claim Tab --->Select Claim ---> Clm View ---> Close Add/Save Notes
True or False; A member can verbally disenroll??
False; They have to submit the request in writing or we can assist them with online assisted disenrollment.
What is the name of the Colorado member portal?
PEAK
Explain how to pull EOB in Facets?
Eligibility Tab ----> Open Macros ---> Medicaid Macros ---> Select B360 ---> Click Policy from Eligibility Screen ---> Detail Benefits will open on webpage
Explain the steps to complete a COB request in Facets? GOOOOOOO!!
COB in Facets and Removal :
Click COB Tab ---> Open Macess in Citix Workspace ---> Open Macros ---> Medicaid Macros ---> Coordination of Benefits ---> Complete request
Who refers to "Tik Tok" as "Tiky Toky"
DANIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
True or False; We can not update the PCP for a Colorado RAE Plan??
True
What percentage of members by LOB do we support for DSNP (RMHP LOB)?
1.22%- You will be servicing the C&S DSNP population, which includes memebers eligible for both Medicare and Medicaid.
What is UNALIGNED and who do we service?
Unaligned - DSNP UHC/Medicaid other MCO - answer only DSNP questions, refer to MCO for Medicaid questions