Medicare 101
What does PPO stand for?
Preferred Provider organization
Dates the ANOC and EOC is sent out to renewing members?
09/3-09/30
NPI/Tax ID
What does CRM stand for?
Customer Relationship Management
What is a Fuzzy Search?
A general provider search
What does HMO stand for?
Health Maintenance Organization
Annual Enrollment period
10/15-12/7
What are the 3 main things that authenticate a member?
Member ID
Zip Code
DOB
What is compass
Mentor
What's a Wildcard Search?
A general member search
What does Beneficiary mean?
The person Receiving benefits
Jan 1 - Dec 31
Policy effective dates
What button do you press when talking to the member?
Interacting with and about
2 ways to access compass
navigation bar
through the case created
If Susie Q is calling on behalf of herself, who is interacting with and who is interacting about?
Susie Q/Susie Q
What does CMS stand for?
Center for Medicaid and Medicare Services
Jan 1 - March 31
Open Enrollment Period
Interacting with
when talking to anyone other than the member
Where can you see news about a case you are following?
Chatter
If Donnie from Dr. Jay's Office is calling to ask about a prior authorization for Mr. Jones, who is Interacting with/about?
Name: Donnie, With: Dr. Jay's Office, About: Mr. Jones
3 things that qualify a person for Medicare?
Turning 65 3 months before and after
disability for 2 years
ESRD
Period when Medicare members can enroll in or change their existing Medicare Advantage plan
Open Enrollment Period
When you get permission over the phone from the member to speak on their behalf
Verbal consent
What page must CRM be on to associate a case to a policy?
Member policy page
What box has to be checked in Quickstart?
G/A rights