MEDICARE 101
HMO stands for?
Health Maintenance Organization
If we are talking to the member what interaction buttons do you press?
Interacting with and about
The amount you pay out of pocket before benefits kick in.
Deductible
What is Part D used for?
Prescription drugs
After how many days do you need to verify Demographics
90
PPO means?
Preferred provider organization
What search field do you use to search cases?
Salesforce Search Bar
Fixed Dollar amount paid when service is rendered
Co-pay
Period when a member is penalized for not having creditable coverage
Late enrollment penalty
What Does HIPAA stand for?
Health Insurance Portability and Accountability ACt
What is PHI
Personal Health Information
What does CRM stand for?
Customer Relationship Management
Co-insurance
Percentage paid upfront when services are rendered
How do you get LIS
Through Social Security
What 3 things do we need to Verify demographics
address
phone number
What is the MAIN qualifier for Medicare?
Turning 65 (3months before or after)
What page do you find consent or POA on file?
Policy Details Screen
Out of pocket limit a person will pay over a benefit year
MOOP
Which program allows you to see RX claims?
RxNova
What 2 things can be used to authenticate a provider?
NPI/Tax ID
When is OEP?
Jan 1st- March 31st
What page needs to be showing to associate a case to CRM?
The member policy page
What kind of plan has Out of Network Cost/benefits
PPO
Which program allows you to see drug cost
RxConnect
What 3 things can we use to authenticate a member?
Member ID
DOB
Zipcode